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2010 Annual Meeting Abstracts

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The CT Diagnosis of Pneumatosis Intestinalis: Clinical Measures Predictive of the Need for Surgical Intervention
*Vincent Duron1, *Sandra Rutigliano2, *Jason Machan1, *Damian Dupuis3, Peter Mazzaglia1
1Brown Medical School, Department of Surgery, Providence, RI;2Brown Medical School, Providence, RI;3Brown Medical School, Department of Radiology, Providence, RI

Objective
To determine which clinical and radiographic parameters correlate with positive operative findings in patients with pneumatosis intestinalis on computed tomography (CT).
Design
Retrospective chart review.
Setting
Tertiary care hospital and affiliated community hospital.
Patients
150 consecutive patients diagnosed with pneumatosis intestinalis on CT at Rhode Island Hospital and The Miriam Hospital.
Interventions
None
Main Outcome Measures
Presence or absence of abdominal pathology at laparotomy and mortality rates.
Results
Of the 150 patients studied, 36% were managed non-operatively (n=54), 49% were managed operatively (n=73), and 15% were made comfort measures only (n=23). Forty percent of all patients improved with non-operative management or had negative intra-operative findings (n=60). In the non-operative group, 91% improved (n=49), 6% crossed over to surgery (n=3), and 4% expired (n=2). In the operative group, 88% had operative findings requiring intervention (n=64), 12% had a negative exploration (n=9), and 28% expired (n=21). Univariate analysis identified numerous clinical and radiogaphic parameters that correlated with positive intra-operative findings, including age>60 (odds ratio (OR)=2.93, P=0.01), atherosclerosis on CT (OR= 2.52, P=0.015), peritonitis (OR=4.65, P=0.003), abdominal distension (OR=4.59, P=<0.001), tachycardia (OR=3.27, P=0.002), tachypnea (OR=7.02, P=0.003), and lactic acidosis (odds per unit increase=1.727, P=0.022).
Conclusions
Many patients with pneumatosis intestinalis on CT can be successfully managed non-operatively. In determining a management strategy, abnormal physical exam findings, more so than laboratory values or radiographic findings, were most predictive of the need for surgical intervention.


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