Brief Article
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World J Gastroenterol. Oct 21, 2013; 19(39): 6579-6584
Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6579
Computed tomography findings of pneumatosis and portomesenteric venous gas in acute bowel ischemia
Marco Milone, Matteo Nicola Dario Di Minno, Mario Musella, Paola Maietta, Vittorio Iaccarino, Giovanni Barone, Francesco Milone
Marco Milone, Matteo Nicola Dario Di Minno, Mario Musella, Paola Maietta, Vittorio Iaccarino, Francesco Milone, Department of Advanced Biomedical Science, University “Federico II” of Naples, 80131 Naples, Italy
Giovanni Barone, Department of Surgery, “Fatebenefratelli” Hospital in Naples, 80123 Naples, Italy
Author contributions: Milone M and Di Minno MND designed the report and wrote the manuscript; Iaccarino V performed the image diagnosis; Maietta P acquired the data; Musella M and Barone G analysed and interpreted the data; Milone F provided the final approval of the version to be published.
Correspondence to: Marco Milone, MD, Department of Advanced Biomedical Science, University “Federico II”, Via Pansini 5, 80131 Naples, Italy. milone.marco@alice.it
Telephone: +39-81-7463067 Fax: +39-81-7462896
Received: February 4, 2013
Revised: April 2, 2013
Accepted: May 19, 2013
Published online: October 21, 2013
Abstract

AIM: To use more representative sample size to evaluate whether computed tomography (CT) scan evidence of the concomitant presence of pneumatosis and portomesenteric venous gas is a predictor of transmural bowel necrosis.

METHODS: Data from 208 patients who were referred for a diagnosis of bowel ischemia were retrospectively reviewed. Only patients who underwent a surgical intervention following a diagnosis of bowel ischemia who also had a post-operative histological confirmation of such a diagnosis were included. Patients were split into two groups according to the presence of histological evidence of transmural bowel ischemia (case group) or partial bowel ischemia (control group). CT images were reviewed for findings of ischemia, including mural thickening, pneumatosis, bowel distension, portomesenteric venous gas and arterial or venous thrombi.

RESULTS: A total of 248 subjects who underwent surgery for bowel ischemia were identified. Among the 208 subjects enrolled in our study, transmural bowel necrosis was identified in 121 subjects (case group), and partial bowel necrosis was identified in 87 subjects (control group). Based on CT findings, including mural thickening, bowel distension, pneumatosis, pneumatosis plus portomesenteric venous gas and presence of thrombi or emboli, there were no significant differences between the case and control groups. The concomitant presence of pneumatosis and porto-mesenteric venous gas showed an odds ratio of 1.95 (95%CI: 0.491-7.775, P = 0.342) for the presence of transmural necrosis. The presence of pneumatosis plus porto-mesenteric venous gas exhibited good specificity (83%) but low sensitivity (17%) in the identification of transmural bowel infarction. Accordingly, the positive and negative predictive values were 60% and 17%, respectively.

CONCLUSION: Although pneumatosis plus porto-mesenteric venous gas is associated with bowel ischemia, we have demonstrated that their co-occurrence cannot be used as diagnostic signs of transmural necrosis.

Keywords: Bowel ischemia, Pneumatosis, Mesenteric venous gas, Computed tomography

Core tip: Although the finding of pneumatosis plus porto-mesenteric venous gas is useful in verifying transmural necrosis with a specificity of 83%, the very low sensitivity of 17% indicates that the diagnosis of transmural necrosis cannot be excluded based on a normal findings. Thus, our results appear to be encouraging by indicating that neither portomesenteric venous gas nor pneumatosis were pathognomonic of bowel transmural infarction.