Start date
03/01/2011
Primary investigator
Joe DuBose, MD, FACS
jjd3c@yahoo.com
(410) 328-0241
University of Maryland, R Adams Cowley Shock Trauma Center 22 South Greene Street, T5R46
Baltimore, MD 21201
Number of sites
1
Existing site names
University of Maryland, R Adams Cowley Shock Trauma Center
Sponsoring organization
None
Abstract
Pneumatosis intestinalis (PI), or the finding of gas within the bowel wall on abdominal imaging, may be associated with numerous conditions in the adult, ranging from benign to life-threatening. The true incidence of PI is unknown, but the expanded utilization of CT imaging appears to have increased the detection of this pathology. Physical exam remains a mainstay of initial evaluation, as patients with peritoneal signs typically mandate operative exploration to rule out intestinal perforation or ischemia. When the exam is compromised by sedation or other factors, however, other evaluation tools may be required to assist in determining the indications for operative intervention. Serum lactate evaluation has proven potentially useful, with one retrospective study conducted by Hawn MT et al. demonstrating that lactate values of > 2.0 mmol/L were associated with a greater than 80% mortality. The presence of hyperlactemia, however, may result from a number of causes unrelated to intestinal ischemia. Other radiographic findings may be of significant import, as it has been suggested that the detection of associated hepatic portal and portomesenteric venous gas may increase the possibility that PI is due to life-threatening causes. These radiographic findings do, however, occur with or without PI as a result of benign non-ischemic conditions. There are many benign and life-threatening causes of PI, with similar radiographic appearances. Correlation with clinical history, examination, and laboratory evaluations are required, but may be confounded by other clinical factors. To date, all series of PI outcomes consist of case reports and small retrospective series. There is a need for a multicenter trial to expand our understanding of the appropriate management of pneumatosis intestinalis. It is our proposal to conduct a multicenter retrospective evaluation of patients with pneumatosis intestinalis as a radiographic finding.