Pneumatosis intestinalis in patients receiving tube feeds

Alexander C. Cavalea, Robert Heidel, Brian Daley, Christy M. Lawson, Darrell A. Benton, James Mcloughlin

Research output: Contribution to journalArticle

Abstract

Pneumatosis intestinalis (PI) identified on computed tomography (CT) suggests an underlying pathology including bowel ischemia. Patients receiving tube feeds can develop PI, potentially requiring surgical intervention. We identify clinical factors in PI to predict those that may be safe to observe versus those that need immediate intervention. We retrospectively reviewed patients from a single institution from 2008 to 2016 with CT findings of PI and an enteric feeding tube. Patients who had not received tube feeds within one week of the CT were excluded. We analyzed clinical, operative, and outcome data to differentiate benign from pathologic outcomes. P values < 0.05 were set as significant. Forty patients were identified. We classified 24 as benign (no intervention) and 16 as pathologic (requiring intervention). A pathologic outcome was demonstrated for free fluid on CT [odds ratio (OR) 5 5.00, confidence interval (CI) 1.23-20.30, P 5 0.03)], blood urea nitrogen (BUN) elevation (OR 5 8.27, CI 1.53-44.62, P 5 0.01), creatinine (Cr) elevation (OR 5 5.00, CI 1.27-19.62, P 5 0.02), BUN/Cr ratio >30 (OR 5 8.57, CI 1.79-40.98, P 5 0.006), and vomiting/ feeding intolerance (OR 5 9.38, CI 1.64-53.62, P 5 0.01). Bowel function within 24 hours of the CT, bowel dilatation (small ‡ 3 cm; large ‡6 cm), and lactic acidemia were not significant. Peritonitis was only seen in pathologic states, but this did not reach statistical significance (P 5 0.06). This represents the largest single-center retrospective analysis of tube feeding-induced PI to date. The presence of free fluid on CT, BUN and Cr elevation, BUN/Cr >30, vomiting/feeding intolerance and peritonitis were predictive of a pathologic etiology of PI.

Original languageEnglish (US)
Pages (from-to)825-831
Number of pages7
JournalAmerican Surgeon
Volume83
Issue number8
StatePublished - Aug 1 2017

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Tomography
Blood Urea Nitrogen
Enteral Nutrition
Peritonitis
Vomiting
Dilatation
Milk
Ischemia
Pathology

All Science Journal Classification (ASJC) codes

  • Surgery
  • Medicine(all)

Cite this

Pneumatosis intestinalis in patients receiving tube feeds. / Cavalea, Alexander C.; Heidel, Robert; Daley, Brian; Lawson, Christy M.; Benton, Darrell A.; Mcloughlin, James.

In: American Surgeon, Vol. 83, No. 8, 01.08.2017, p. 825-831.

Research output: Contribution to journalArticle

Cavalea, AC, Heidel, R, Daley, B, Lawson, CM, Benton, DA & Mcloughlin, J 2017, 'Pneumatosis intestinalis in patients receiving tube feeds', American Surgeon, vol. 83, no. 8, pp. 825-831.
Cavalea, Alexander C. ; Heidel, Robert ; Daley, Brian ; Lawson, Christy M. ; Benton, Darrell A. ; Mcloughlin, James. / Pneumatosis intestinalis in patients receiving tube feeds. In: American Surgeon. 2017 ; Vol. 83, No. 8. pp. 825-831.
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