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An approach to pneumatosis intestinalis: Factors affecting your management.

Tahiri M, Levy J, Alzaid S, Anderson D - Int J Surg Case Rep (2014)

Bottom Line: PI is an ominous condition often requiring emergent surgery.The management can be challenging in some circumstances, as the choice of surgery versus medical treatment can be difficult.Secondly, we review the existing literature regarding the management of PI and we suggest a treatment algorithm based on clinical, laboratory and radiological findings.

View Article: PubMed Central - PubMed

Affiliation: Saint Mary's Hospital, Division of General Surgery, McGill University, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Canada. Electronic address: mehdi.tahirihassani@mail.mcgill.ca.

No MeSH data available.


Related in: MedlinePlus

Abdominal X-ray series.
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fig0005: Abdominal X-ray series.

Mentions: On arrival to the ED, the patient was hemodinamycally stable and afebrile. Abdominal exam showed a distended and tympanic abdomen without tenderness or guarding. Her laboratory tests were unremarkable except for an elevated serum lactate, of 2.1 mmol/L. To further investigate this pain, an abdominal series was requested to rule out an abdominal obstruction. The X-rays showed several air-fluid levels with slightly dilated small bowel (Fig. 1). A computed tomography (CT) of the abdomen with intravenous (IV) contrast was then requested in order to identify the cause of this possible small bowel obstruction. The CT scan showed the presence of mild to moderate small bowel obstruction with a transition point toward the mid bowel. There was extensive pneumatosis intestinalis involving small bowel distal to the transition point. The CT scan confirmed patent arterial vascularity and a small amount of gas was noted in the portal venous system (Fig. 2). Of note, a CT abdomen with IV contrast taken 15 months prior to rule out obstruction was unremarkable. Given the patient's pain, the new findings on her CT and her slightly elevated lactate, the decision was made to proceed with an exploratory laparotomy. Our intraoperative findings showed extensive mesenteric emphysema in a large part of the small intestine with no small bowel compromise and no identifiable transition point (Fig. 3).


An approach to pneumatosis intestinalis: Factors affecting your management.

Tahiri M, Levy J, Alzaid S, Anderson D - Int J Surg Case Rep (2014)

Abdominal X-ray series.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4334205&req=5

fig0005: Abdominal X-ray series.
Mentions: On arrival to the ED, the patient was hemodinamycally stable and afebrile. Abdominal exam showed a distended and tympanic abdomen without tenderness or guarding. Her laboratory tests were unremarkable except for an elevated serum lactate, of 2.1 mmol/L. To further investigate this pain, an abdominal series was requested to rule out an abdominal obstruction. The X-rays showed several air-fluid levels with slightly dilated small bowel (Fig. 1). A computed tomography (CT) of the abdomen with intravenous (IV) contrast was then requested in order to identify the cause of this possible small bowel obstruction. The CT scan showed the presence of mild to moderate small bowel obstruction with a transition point toward the mid bowel. There was extensive pneumatosis intestinalis involving small bowel distal to the transition point. The CT scan confirmed patent arterial vascularity and a small amount of gas was noted in the portal venous system (Fig. 2). Of note, a CT abdomen with IV contrast taken 15 months prior to rule out obstruction was unremarkable. Given the patient's pain, the new findings on her CT and her slightly elevated lactate, the decision was made to proceed with an exploratory laparotomy. Our intraoperative findings showed extensive mesenteric emphysema in a large part of the small intestine with no small bowel compromise and no identifiable transition point (Fig. 3).

Bottom Line: PI is an ominous condition often requiring emergent surgery.The management can be challenging in some circumstances, as the choice of surgery versus medical treatment can be difficult.Secondly, we review the existing literature regarding the management of PI and we suggest a treatment algorithm based on clinical, laboratory and radiological findings.

View Article: PubMed Central - PubMed

Affiliation: Saint Mary's Hospital, Division of General Surgery, McGill University, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Canada. Electronic address: mehdi.tahirihassani@mail.mcgill.ca.

No MeSH data available.


Related in: MedlinePlus