Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis

European Journal of Medical Research

K-G Kanz²  K Hallfeldt⁴  W Mutschler¹  M Siebeck⁴  A Kleespies³  R Ladurner⁴  S Huber-Wagner¹  PN Khalil² 

[1] Division of Trauma Surgery, Department of Surgery, Downtown Medical Centre, Ludwig-Maximilians University, Munich, Germany;Division of Emergency Medicine, Department of Surgery, Downtown Medical Centre, Ludwig-Maximilians University, Munich, Germany;Department of Surgery, Großhadern Medical Centre, Ludwig-Maximilians University, Munich, Germany;Division of General and Visceral Surgery, Department of Surgery, Downtown Medical Centre, Ludwig-Maximilians University, Munich, Germany

关键词: abdominal imaging;    abdominal emergencies;    gastrointestinal pathophysiology;    gastrointestinal tract;    Pneumatosis intestinalis;   

Others  :  1093756
DOI  :  10.1186/2047-783X-14-6-231

 received in 2009-05-03, accepted in 2009-05-07,  发布年份 2009

【 摘 要 】

Objective

Pneumatosis intestinalis has been increasingly detected in recent years with the more frequent use of computed tomography for abdominal imaging of the intestine. The underlying causes of the gas found during radiographic studies of the bowel wall can vary widely and different hypotheses regarding its pathophysiology have been postulated. Pneumatosis intestinalis often represents a benign condition and should not be considered an argument for surgery. However, it can also require life-threatening surgery in some cases, and this can be a difficult decision in some patients.

Methods

The spectrum of pneumatosis intestinalis is discussed here based on various computed tomographic and surgical findings in patients who presented at our University Medical Centre in 2003-2008. We have also systematically reviewed the literature to establish the current understanding of its aetiology and pathophysiology, and the possible clinical conditions associated with pneumatosis intestinalis and their management.

Results

Pneumatosis intestinalis is a primary radiographic finding. After its diagnosis, its specific pathogenesis should be ascertained because the appropriate therapy is related to the underlying cause of pneumatosis intestinalis, and this is sometimes difficult to define. Surgical treatment should be considered urgent in symptomatic patients presenting with an acute abdomen, signs of ischemia, or bowel obstruction. In asymptomatic patients with otherwise inconspicuous findings, the underlying disease should be treated first, rather than urgent exploratory surgery considered. Extensive and comprehensive information on the pathophysiology and clinical findings of pneumatosis intestinalis is provided here and is incorporated into a treatment algorithm.

Conclusions

The information presented here allows a better understanding of the radiographic diagnosis and underlying aetiology of pneumatosis intestinalis, and may facilitate the decision-making process in this context, thus providing fast and adequate therapy to particular patients.

【 授权许可】

   
2009 I. Holzapfel Publishers

【 图 表 】

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