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- Title
Outcomes of patients with pneumatosis intestinalis and/or portal venous gas: a study of factors associated with survival and surgical intervention.
- Authors
Wong, Ngar Lok Joshua; Paredes, Steven Ronald; Seyfi, Doruk; Ng, Kheng‐Seong
- Abstract
Backgrounds: This study investigated the incidence of, and mortality and management outcomes following, pneumatosis intestinalis and/or portal venous gas on computed tomography. Methods: A retrospective study of patients identified with pneumatosis intestinalis and/or portal venous gas on computed tomography at a quaternary centre (2013–2021) was performed. Data relating to clinical presentation (including quick sequential organ failure assessment score), co‐morbidities (Charlson Comorbidity Index), biochemical data (including peak lactate level), and radiological findings, were obtained. Factors associated with these were assessed by logistic regression. Results: From 16 428 scans, 107 (0.65%) demonstrated pneumatosis intestinalis and/or portal venous gas (mean 65.2 years [SD 15.2]; 60 [56%] male). Overall, 37 patients (35%) had both findings present. Thirty‐three deaths (31%) were recorded. Fifty‐four patients (51%) underwent surgery. Death was associated with quick sequential organ failure assessment score (score 1: OR 5.71, 95% CI 1.31–24.87; score 2: OR 10.00, 95% CI 1.94–51.54), Charlson Comorbidity Index ≥5 (OR 2.86, 95% CI 1.19–6.84), peak lactate ≥2.6 mmol/L (OR 14.53, 95% CI 4.39–48.14), and concomitant pneumatosis intestinalis and portal venous gas (OR 8.25, 95% CI 3.04–22.38). The presence of free peritoneal fluid (OR 3.23, 95% CI 1.44–7.28) or perforated viscus (OR 5.10, 95% CI 1.05–24.85) were the only predictors for surgery. Conclusion: Pneumatosis intestinalis and portal venous gas are rare findings. Despite traditionally portending a poor prognosis, mortality occurred in only one‐third of patients. There were clear indicators of mortality viz. sepsis severity, comorbidities, and concomitant pneumatosis intestinalis and portal venous gas. Factors predicting surgery warrant further investigation.
- Subjects
ENTEROCOLITIS; COMPUTED tomography; ASCITIC fluids; NOBLE gases; GASES; LOGISTIC regression analysis
- Publication
ANZ Journal of Surgery, 2024, Vol 94, Issue 4, p640
- ISSN
1445-1433
- Publication type
Article
- DOI
10.1111/ans.18875