TY - JOUR
T1 - Pneumatosis and portal venous gas
T2 - Do CT findings reassure?
AU - Hani, Murad Bani
AU - Kamangar, Farin
AU - Goldberg, Sarah
AU - Greenspon, Jose
AU - Shah, Priti
AU - Volpe, Carmine
AU - Turner, Douglas J.
AU - Horton, Karen
AU - Fishman, Elliot K.
AU - Francis, Isaac R.
AU - Daly, Barry
AU - Cunningham, Steven C.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2013/12
Y1 - 2013/12
N2 - Background: Small, single-institution studies have suggested risk factors for bowel ischemia/necrosis (I/N) in patients with computed tomography (CT) findings of pneumatosis (PN) and portal venous gas (PVG). Here, analysis has been expanded in a large, multicenter study. Materials &methods: Logistic regression models and receiver operating characteristic curves were used to construct a scoring system for I/N in cases of PN/PVG. Results: Of 265 patients with PN/PVG identified, 209 had adequate data. In unadjusted analyses the following variables were significantly associated with I/N: age, peritoneal signs, ascites, the presence of both PVG and PN, blood urea nitrogen (BUN), CO2, albumin, and a history of hypertension, myocardial infarction, or stroke. In contrast, the CT findings of mesenteric stranding, bowel-wall thickening, and type of PN were not associated with I/N. In adjusted analyses, three variables were significantly associated with I/N: age ≥60 y (odds ratio = 2.51, 95% confidence interval: 1.26-4.97), peritoneal signs (10.58, 4.23-26.4), and BUN >25 mg/dL (3.08, 1.54-6.17), whereas presence of both PN and PVG (versus only one) was associated with an increase (but not statistically significant increase) in odds (2.01, 0.94-4.36). Although several ad hoc models were used to maximize diagnostic ability, with maximal odds ratio = 174, the areas of receiver operating characteristic curves were all below 0.80, revealing suboptimal accuracy to diagnose I/N. Conclusions: Older age, peritoneal signs, and high BUN are associated with I/N, suggesting an ability to predict which patients need operation. CT findings traditionally suggestive of ischemic PN/PVG, however, do not diagnose I/N accurately enough to reliably identify patients needing operation.
AB - Background: Small, single-institution studies have suggested risk factors for bowel ischemia/necrosis (I/N) in patients with computed tomography (CT) findings of pneumatosis (PN) and portal venous gas (PVG). Here, analysis has been expanded in a large, multicenter study. Materials &methods: Logistic regression models and receiver operating characteristic curves were used to construct a scoring system for I/N in cases of PN/PVG. Results: Of 265 patients with PN/PVG identified, 209 had adequate data. In unadjusted analyses the following variables were significantly associated with I/N: age, peritoneal signs, ascites, the presence of both PVG and PN, blood urea nitrogen (BUN), CO2, albumin, and a history of hypertension, myocardial infarction, or stroke. In contrast, the CT findings of mesenteric stranding, bowel-wall thickening, and type of PN were not associated with I/N. In adjusted analyses, three variables were significantly associated with I/N: age ≥60 y (odds ratio = 2.51, 95% confidence interval: 1.26-4.97), peritoneal signs (10.58, 4.23-26.4), and BUN >25 mg/dL (3.08, 1.54-6.17), whereas presence of both PN and PVG (versus only one) was associated with an increase (but not statistically significant increase) in odds (2.01, 0.94-4.36). Although several ad hoc models were used to maximize diagnostic ability, with maximal odds ratio = 174, the areas of receiver operating characteristic curves were all below 0.80, revealing suboptimal accuracy to diagnose I/N. Conclusions: Older age, peritoneal signs, and high BUN are associated with I/N, suggesting an ability to predict which patients need operation. CT findings traditionally suggestive of ischemic PN/PVG, however, do not diagnose I/N accurately enough to reliably identify patients needing operation.
KW - CT
KW - Computed tomography
KW - Intestine
KW - Ischemia
KW - Necrosis
KW - Pneumatosis
KW - Portal venous gas
KW - Scoring system
UR - http://www.scopus.com/inward/record.url?scp=84891692262&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84891692262&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2013.06.006
DO - 10.1016/j.jss.2013.06.006
M3 - Article
C2 - 23845870
AN - SCOPUS:84891692262
SN - 0022-4804
VL - 185
SP - 581
EP - 586
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 2
ER -