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Invited Critique
May 2011May 16, 2011

Sorting Through the Evidence of Adult Pneumatosis Intestinalis as a Harbinger for Disaster vs Benign Disease: Comment on “Computed Tomographic Diagnosis of Pneumatosis Intestinalis”

Author Affiliations

Author Affiliations: Department of Surgery, Bridgeport Hospital, Yale New Haven Health, Bridgeport (Dr Atweh), and Department of Surgery, Yale University School of Medicine/Yale[[ndash]]New Haven Hospital, New Haven (Dr Starker), Connecticut.

Arch Surg. 2011;146(5):511. doi:10.1001/archsurg.2011.96

Since pneumatosis intestinalis was first described by Duvernoy in 1754,1 interest in deciphering its etiology, progression, and optimal management has shown a broad spectrum of presentation and prognosis. With the increased use of abdominal CT, more cases are being diagnosed.

Duron and colleagues have accumulated the largest series to date of patients diagnosed as having pneumatosis intestinalis using a CT data registry. They have confirmed that pneumatosis intestinalis detected radiographically is not an independent variable in determining the need for operative intervention. Radiographic studies should be used as an adjunct to physical examination and other clinical data. The spectrum of outcomes in their study correlates with the multiple causes of this pathological finding. Older studies revealed a high concentration of hydrogen gas in the subserosal pockets, supporting anaerobic bacterial fermentation as a cause.2 Gas occasionally seeps into the peritoneal cavity or portomesenteric circulation. This may suggest a disruption of mucosal integrity by increased intraluminal pressure or overgrowth of anaerobic bacteria that could be facilitated by an autoimmune disease or ischemia.2