Pneumatosis intestinalis in adults: Management, surgical indications, and risk factors for mortality

Alexander J. Greenstein, Scott Q. Nguyen, Ana Berlin, Jacqueline Corona, Jonathan Lee, Everlyn Wong, Stephanie H. Factor, Celia M. Divino

Research output: Contribution to journalArticlepeer-review

114 Scopus citations

Abstract

Pneumatosis intestinalis (PI) is an unusual finding that can exist in a benign setting but can indicate ischemic bowel and the need for surgical intervention. We present a series of cases of PI in adults to illustrate factors associated with death and surgical intervention. We reviewed the radiology database of the Mount Sinai Medical Center for cases of PI between 1996-2006 in adult patients. Chi-square and multivariable logistic regression analyses were used to identify factors significant for surgery and death. Forty patients developed PI over a 10-year span. The overall in-hospital mortality rate was 20%, and the surgical rate was 35%. Factors independently associated with surgical management on multivariable analysis were age∈ ∈60 years (p∈=∈0.03), the presence of emesis (p∈=∈0.01), and a WBC∈>∈12 c/mm3 (p∈=∈0.03). Pre-existing sepsis was independently associated with mortality (p∈=∈0.03) while controlling for surgery. Patients with the concomitant presence of PI, a WBC∈>∈12 c/mm3, and/or emesis in the >60-year-old age group were most likely to have surgical intervention, whereas PI patients with sepsis had the highest risk for death. A management algorithm is proposed, but further research will be needed to determine which patients with PI may benefit most from surgery.

Original languageEnglish
Pages (from-to)1268-1274
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume11
Issue number10
DOIs
StatePublished - Oct 2007
Externally publishedYes

Keywords

  • Cyst
  • Gas
  • Intestinalis
  • Ischemia
  • Pneumatosis
  • Pneumoperitoneum

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