PNEUMATOSIS-INTESTINALIS IN ADULTS WITH AIDS - CLINICAL-SIGNIFICANCE AND IMAGING FINDINGS

OBJECTIVE. The significance of pneumatosis intestinalis in adults with AIDS is unknown. Adults with AIDS are predisposed to pneumatosis inte stinalis. The purpose of this study is to determine the clinical signi ficance and to characterize the imaging appearance of this finding in patients with AIDS. MATERIALS AND METHODS. In just over 3 years at our institution, pneumatosis intestinalis in adults with AIDS was detecte d in six cases. Medical records of those cases were retrospectively an alyzed for clinical history, laboratory data, and surgical and patholo gic findings. CT scans and abdominal radiographs were analyzed for loc ation and severity of pneumatosis, presence of portal venous gas, pneu moperitoneum, and cystic versus linear gas. RESULTS. Five of the six p atients with AIDS-associated pneumatosis intestinalis were managed con servatively or medically without surgical procedures and were discharg ed from the hospital with resolved or decreasing gastrointestinal comp laints. The other patient underwent an exploratory laparotomy because of free intraperitoneal and retroperitoneal air; however, no bowel per foration was found at surgery. CONCLUSION. Pneumatosis intestinalis is a late-stage phenomenon in adult patients with AIDS that characterist ically involves the cecum or right colon. Pneumatosis in patients with AIDS may be an indolent abnormality and does not necessarily constitu te a surgical emergency or a sign of impending bowel necrosis.