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J Gastrointest Surg. 2007 Oct;11(10):1268-74. Epub 2007 Aug 9.

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

Author information

1
Department of Surgery, The Mount Sinai Medical Center, 5 E. 98th Street, 15th Floor, P.O. Box 1259, New York, NY 12029, USA.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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 >or= 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.

CONCLUSION:

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.

PMID:
17687617
DOI:
10.1007/s11605-007-0241-9
[Indexed for MEDLINE]

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