Gastric pneumatosis: Laboratory and imaging findings associated with mortality in adults

• In gastric pneumatosis mortalities, serum lactic acid & creatinine was higher than in survivors.
• Small or large bowel pneumatosis with gastric pneumatosis was uniformly associated with death.
• Survivors & mortalities did not differ in presence of portal or mesenteric venous gas or free air.

AimTo describe laboratory and imaging findings associated with mortality in patients with gastric pneumatosis.Materials and methodsInstitution review board approval was obtained for this retrospective study. Using radiology report databases, all patients with “gastric pneumatosis” or “emphysematous gastritis” in their CT reports were identified from two institutions during 12 or 9 year periods. Clinical parameters and laboratory values [lactic acid, white blood cell (WBC) count, and serum creatinine] were obtained from medical records and images were reviewed in consensus by two readers. Bivariate associations between continuous variables were tested by Mann–Whitney tests. Fisher’s exact test was used to evaluate bivariate associations between categorical variables.ResultsOf the 24 patients identified, there were five (21%) deaths. Median serum lactic acid and creatinine levels were significantly higher in patients who died compared to surviving patients [median (interquartile range, IQR): 1.95 (1.45–4.15) versus 1.5 (1.3–2.6), p = 0.001; 1.2 (1–2.8) versus 1 (0.8–1.4), p = 0.005, respectively). There was no significant difference in WBC levels between the groups. Coexistent small bowel pneumatosis and colonic pneumatosis were significantly more common in patients who died compared to surviving patients (80% versus 0%, p < 0.001; 40% versus 0%, p = 0.04, respectively). There was no significant difference for portal or mesenteric venous gas, free intraperitoneal gas, or dilated bowel.ConclusionsWhen the imaging finding of gastric pneumatosis was associated with elevated serum lactic acid, elevated serum creatinine, or concomitant small bowel or colonic pneumatosis, an association with mortality was observed. These findings suggest that more aggressive treatment may be warranted in patients with these laboratory or imaging abnormalities.