Pneumatosis intestinalis and portal venous gas in mechanical small bowel obstruction: Is it worrisome? - 22/05/21

Doi : 10.1016/j.diii.2021.05.001

Paul Lebert ^a,⁎ , Olivier Ernst ^a, Marc Zins ^b, Marie Lanchou ^a, Jean-Robert Nzamushe ^c, Mathilde Vermersch ^a
^a Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
^b Department of Radiology, Fondation Hôpital Saint-Joseph, 75014 Paris, France
^c Department of Emergency Surgery, Lille University Hospital, 59037 Lille Cedex, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 22 May 2021
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Highlights

•	Pneumatosis and portal venous gas are rarely encountered in mechanical small bowel obstruction.
•	Pneumatosis and portal venous gas are not associated with permanent ischemia or resection.
•	Pneumatosis and portal venous gas are rarely worrisome in mechanical small bowel obstruction.

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Abstract

Purpose

The purpose of this study was to evaluate the clinical significance of pneumatosis intestinalis (PI) and portal venous gas (PVG) in patients with mechanical small bowel obstruction (SBO), using surgical findings or clinical follow-up as standard of reference.

Materials and methods

Fourteen patients with mechanical SBO associated with PI and PVG were retrospectively included. There were 7 men and 7 women with a mean age of 59±19 (SD) (range: 25–93 years). CT examinations were reviewed by two radiologists to confirm the diagnosis of mechanical SBO and make a description of PI. Interobserver agreement was calculated. The reference standard was intraoperative appearance of the bowel wall (10/14; 71%) or the recovery of a normal bowel function in patients who were managed conservatively (4/14; 29%).

Results

Among the 10 patients who underwent surgery, a normal appearance of the bowel in association with PI on CT was found intraoperatively in 8/10 (80%) patients and a reversible ischemia in the remaining 2/10 (20%) patients. The four patients who were managed conservatively recovered normal bowel function. Two patients died within two weeks following SBO.