Pneumatosis intestinalis in adults: Management, surgical indications, and risk factors for mortality

Background Pneumatosis intestinalis ( PI) is an unusual finding that can exist in a benign setting but can indicate ischemic bowel and the need for surgical intervention. We present a series of cases of PI in adults to illustrate factors associated with death and surgical intervention. Methods We reviewed the radiology database of the Mount Sinai Medical Center for cases of PI between 1996 - 2006 in adult patients. Chi- square and multivariable logistic regression analyses were used to identify factors significant for surgery and death. Results Forty patients developed PI over a 10- year span. The overall in- hospital mortality rate was 20%, and the surgical rate was 35%. Factors independently associated with surgical management on multivariable analysis were age >= 60 years ( p= 0.03), the presence of emesis ( p= 0.01), and a WBC> 12 c/ mm(3) ( p= 0.03). Pre- existing sepsis was independently associated with mortality ( p= 0.03) while controlling for surgery. Conclusion Patients with the concomitant presence of PI, a WBC> 12 c/ mm(3), and/ or emesis in the > 60- year- old age group were most likely to have surgical intervention, whereas PI patients with sepsis had the highest risk for death. A management algorithm is proposed, but further research will be needed to determine which patients with PI may benefit most from surgery.