Estimating the risk of bowel ischemia requiring surgery in patients with tomographic evidence of pneumatosis intestinalis

BackgroundPneumatosis intestinalis (PI) presents a challenging dilemma for surgeons given its association with both benign and life threatening conditions. As such, the need for surgical intervention is oftentimes difficult to discern. We hypothesize that a clinical nomogram can be used to predict the need for surgical intervention in patients with PI.MethodsWe performed a retrospective review of 217 consecutive cases with PI on abdominal computed tomography over a 10-year period at a tertiary care hospital. Bivariable and multivariable analysis were conducted to assess the statistical significance of the association between patient factors and need for surgical intervention, defined as positive findings at surgery.ResultsThere were 217 patients with PI identified during the study, of which 178 were treated with curative intent. Of these, 82 patients underwent surgical exploration, and 96 patients were managed conservatively. Forty-four percent of patients who had radiographic evidence of PI were managed conservatively and did well, whereas an additional 6% underwent nontherapeutic laparotomies. Multivariable analysis demonstrated that patients with tenderness on examination, lactic acidosis, and tachycardia had significantly higher likelihood of the need for surgical intervention, whereas patients with diabetes had a lower likelihood of surgical intervention. These and other selected patient characteristics can be used to efficiently and reliably estimate the probability of ischemic bowel at laparotomy.ConclusionsThe presence of PI does not always warrant surgical intervention. We present a nomogram to assist with clinical decision-making based on the presence of clinical factors.