Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: Correlation of CT findings with severity of ischemia and clinical outcome

OBJECTIVE. The purpose of this study was to analyze the correlation between pneumatosis or portomesenteric venous gas; or both, the severity of mural involvement, and the clinical outcome in patients with small- or large-bowe l ischemia. MATERIALS AND METHODS. CT scans of 23 consecutive patients presenting with pneumatosis or portomesenteric venous gas caused by bowel ischemia were rev iewed. The presence and extent of both CT findings were compared with the c linical outcome in all patients and with the severity and extent of ischemi c bowel wall damage as determined by surgery (15 patients), autopsy (three patients), or follow-up (five patients). RESULTS: Seven patients showed isolated pneumatosis, and 16 patients showed portomesenteric venous gas with or without pneumatosis (11 and five patien ts, respectively). Pneumatosis and portomesenteric venous gas were associat ed with transmural bowel infarction in 14 (78%) of 18 patients and 13 (81%) of 16 patients, respectively. Nine patients (56%) with portomesenteric ven ous gas died. Of seven patients with infarction limited to one bowel segmen t (jejunum, ileum, or colon)., only one patient (14%) died, whereas of the 10 patients with infarction of two or three bowel segments, eight patients (80%) died. CONCLUSION. CT findings of pneumatosis intestinalis and portomesenteric ven ous gas due to bowel ischemia do not generally allow prediction of transmur al bowel infarction, because they may be observed in patients with only par tial ischemic bowel wall damage. The clinical outcome of patients with bowe l ischemia with these CT findings seems to depend mainly on the severity an d extent of their underlying disease.