Clinical and CT features of patients with pneumatosis intestinalis

This study investigates the clinical and abdominal computed tomography (CT) characteristics of pneumatosis intestinalis (PI). This retrospective single-center study included 58 patients with PI. Clinical data and CT images were reviewed. CT findings included location, extent, and associated features, and PI was classified into 3 morphological patterns: bandlike, grapelike, and beadlike. Inter-observer agreement was evaluated, and subgroup analysis was performed using analysis of variance and chi-square tests. The mean age of the patients was 68 years. The most common comorbidities were diabetes (44.8%) and hypertension (42.4%). Abdominal pain (62.1%) was the predominant symptom. Inter-observer agreement for CT findings was excellent (kappa 0.88–0.95). The beadlike pattern was most frequent (48.3%), followed by bandlike (34.5%) and grapelike (17.2%). The surgical group (n = 10) was older and had more frequent abdominal pain, peritoneal signs, and ascites (60.0% vs 20.8%, P = .033) than the conservative group (n = 48). Overall prognosis was favorable (96.6% recovery), but both deaths were associated with concurrent portal and mesenteric venous gas. After treatment, a follow-up CT scan obtained 2 to 4 weeks later demonstrated resolution of PI. We propose a novel CT morphological classification method for PI. Clinical signs and specific CT findings (e.g., ascites and portomesenteric venous gas) guide management. While most patients recover with conservative care, concurrent portal and mesenteric venous gas signifies a high mortality risk. CT plays a key role in the follow-up of patients with PI.