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  • Title: [Of what relevance is the diagnosis of "pneumatosis intestinalis" and portal gas for the surgeon?].
    Author: Bausch D, Hopt UT, Obermaier R.
    Journal: Zentralbl Chir; 2009 Jun; 134(3):203-8. PubMed ID: 19536712.
    Abstract:
    Pneumatosis intestinalis (PI) describes the existence of gas in the wall of the gastrointestinal tract; portal gas (PG) describes gas in the portovenous system. Both are predominantly diagnosed radiologically (computed tomography as the most sensitive method) and do not represent per se self-contained syndromes, but PI and PG are possible symptoms of a variety of diseases. Possible sources of gas are bacterial gas (e. g., bowel wall invasion by aerogenic bacteria), intraluminal and extraluminal enteric gas (e. g., increased intraluminal pressure e.g. endoscopy), and pulmonary gas (e. g., COPD). The treatment of PI /PG depends on the underlying disease. The decision for laparotomy/ laparoscopy should be a conclusion of clinical and possibly radiological signs. Since in many cases, the simultaneous detection of PI and PG, is caused by mesenterial ischemia and has a poor prognosis, in these cases, the decision for operation (laparotomy/ laparoscopy) should be made liberally. A symptomatic therapy with metronidazole and oxygen should be considered, if despite the adequate treatment of the underlying disease, PI continues with abdominal symptoms (such as intestinal pseudo-obstruction or nonspecific abdominal pain).
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