E. Insley1, B. Braslow1, Z. Maher1, S. Allen1 1Hospital Of The University Of Pennsylvania,Philadelphia, PA, USA
Introduction: The radiographic finding of pneumatosis intestinalis (PI) raises the concern for ischemic bowel and possible need for urgent surgical intervention. Lactic acidosis, peritonitis, and the systemic inflammatory response have been show to be predictors of surgical pathology in patients with PI, but how immunosuppressant may impact on the reliability of these findings is not well characterized. We hypothesized that the use of immunosuppressants and their effect on physical exam findings in patients with PI would lead one to rely on physiologic and metabolic derangements to base operative decision making.
Methods: The institutional radiology database from our urban academic medical center was queried over a 5 year period for patients with CT scans that had the presence of PI as determined by board-certified radiologists. Radiology reports containing the words “pneumatosis intestinalis” were obtained and the scans were reviewed to confirm the presence of PI. Only the index CT scan of each patient was included. Demographics, comorbidities, laboratory values, physiologic data, and operative findings were abstracted by chart review for these patients. Patients were stratified by immunosupression (defined as steroids, transplant immunosuppressants or recent chemotherapeutic agents) and univariate logistic regression was used to determine the association of these factors with the outcomes of interest including need for operation, therapeutic laparotomy (Ther lap) and in-hospital survival.
Results:A total of 124 patients met inclusion criteria. Demographics were similar between the 2 groups. Statistically more patients in the immunosuppression group presented with > 2 SIRS criteria while lactic acid levels were similar. Other laboratory markers of acid/base status were also similar. There was no difference in the percentage of patients that underwent an operation with over 80% in each group receiving a therapeutic intervention (bowel resection). Those in the immunosuppression group without abdominal pain demonstrated the lowest proportion of a ther lap (Table).
Conclusion:The association between abdominal examination and positive operative findings appears to be similar in immunocompromised and immunocompetent hosts. Additionally, patients taking immune suppressing medications demonstrated the ability to mount an inflammatory response based on defined SIRS criteria. The decision to operate in patients with PI should be based on SIRS criteria, acid base status and abdominal exam in both immunocompetent and immunocompromised patients.
