The spectrum of pneumatosis intestinalis in the adult. A surgical dilemma

Pneumatosis intestinalis (PI) is a striking radiological diagnosis. Formerly a rare diagnostic finding, it is becoming more frequently diagnosed due to the wider availability and improvement of computed tomography scan imaging. Once associated only with poor outcome, its clinical and prognostic sign...

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Published inWorld journal of gastrointestinal surgery Vol. 15; no. 4; pp. 553 - 565
Main Authors Tropeano, Giuseppe, Di Grezia, Marta, Puccioni, Caterina, Bianchi, Valentina, Pepe, Gilda, Fico, Valeria, Altieri, Gaia, Brisinda, Giuseppe
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Inc 27.04.2023
Subjects
Minireviews
Pneumatosis intestinalis
Portal venous gas
Treatment
Portomesenteric pneumatosis
Risk factors
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Summary:Pneumatosis intestinalis (PI) is a striking radiological diagnosis. Formerly a rare diagnostic finding, it is becoming more frequently diagnosed due to the wider availability and improvement of computed tomography scan imaging. Once associated only with poor outcome, its clinical and prognostic significance nowadays has to be cross-referenced to the nature of the underlying condition. Multiple mechanisms of pathogenesis have been debated and multiple causes have been detected during the years. All this contributes to creating a broad range of clinical and radiological presentations. The management of patients presenting PI is related to the determining cause if it is identified. Otherwise, in particular if an association with portal venous gas and/or pneumoperitoneum is present, the eventual decision between surgery and non-operative management is challenging, even for stable patients, since this clinical condition is traditionally associated to intestinal ischemia and consequently to pending clinical collapse if not treated. Considering the wide variety of origin and outcomes, PI still remains for surgeons a demanding clinical entity. The manuscript is an updated narrative review and gives some suggestions that may help make the decisional process easier, identifying patients who can benefit from surgical intervention and those who can benefit from non-operative management avoiding unnecessary procedures.
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Author contributions: Tropeano G and Di Grezia M equally contributed to the drafting of the manuscript and must both be considered first author; Tropeano G, Di Grezia M, Puccioni C, Bianchi V and Brisinda G designed the research; Bianchi V, Pepe G, Fico V and Altieri G performed the research and selected the articles; Tropeano G, Di Grezia M and Puccioni C analyzed the data; Tropeano G, Di Grezia M, Puccioni C and Brisinda G reviewed the selected manuscripts and wrote the paper; All the authors read and approved the final manuscript.
Corresponding author: Giuseppe Brisinda, MD, Professor, Surgeon, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo Agostino Gemelli 8, Rome 00168, Rome, Italy. gbrisin@tin.it
ISSN:1948-9366
1948-9366
DOI:10.4240/wjgs.v15.i4.553