Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea.
Eur J Radiol. 2011 Dec;80(3):629-36. doi: 10.1016/j.ejrad.2010.08.009. Epub 2010 Aug 31.
To evaluate clinical features and CT findings of pneumatois intestinalis in recipients following liver transplantation and to determine whether certain clinical and CT findings enable differentiation of indolent pneumatois intestinalis from fulminant cases.
This retrospective study was approved by our institutional review board, with informed consent waived. Among 2080 liver transplantation recipients at our institution between January 1998 and April 2008, 22 (1%) presented with pneumatois intestinalis on postoperative follow-up. Patients were divided into recovery and mortality groups, and then clinical features and CT findings were compared between two groups.
Although indolent pneumatois intestinalis more frequently presented incidentally (61%) after 2 weeks of surgery (89%) than fulminant pneumatois intestinalis (0, 50%), there were no statistically significant differences (P=.14, .09). Right colon was affected in the recovery group without exception (n=18,100%), and all four patients (100%) in mortality group showed small bowel involvement (P<.05). Caliber changes of superior mesenteric artery and vein in mortality group were significantly greater (49.6%, 67.0%) than those in recovery group (101.7%, 99.0%) (P<.05, respectively). Pneumatois intestinalis in mortality group more commonly accompanied portomesenteric air-embolism, visceral infarction, hemorrhagic ascites, and small bowel ileus than indolent counterpart (P<.05, respectively).
Typical indolent pneumatois intestinalis is found incidentally later than 2 weeks of liver transplantation surgery, but there is some overlap between indolent and fulminant pneumatois intestinalis in terms of onset and mode of presentation. Among CT findings, grave signs are small bowel involvement, caliber changes in mesenteric vessels, portomesenteric air-embolism, visceral infarction, hemorrhagic ascites, and small bowel ileus.
评估肝移植受者发生气腹的临床特征和 CT 表现，并确定某些临床和 CT 特征是否能区分惰性气腹和暴发性气腹。
本回顾性研究经我院机构审查委员会批准，患者均豁免知情同意。在我院 1998 年 1 月至 2008 年 4 月期间进行的 2080 例肝移植受者中，22 例（1%）在术后随访中出现气腹。将患者分为恢复组和死亡组，然后比较两组患者的临床特征和 CT 表现。
尽管 2 周后（89%）出现的隐匿性气腹（61%）较暴发性气腹（0，50%）更为常见，但差异无统计学意义（P=.14，P=.09）。恢复组无一例外（n=18，100%）均累及右半结肠，而死亡组的 4 例患者（100%）均累及小肠（P<.05）。死亡组肠系膜上动、静脉直径变化显著大于恢复组（49.6%，67.0%比 101.7%，99.0%）（P<.05）。与隐匿性气腹相比，死亡组气腹更常伴有门腔静脉积气、内脏梗死、血性腹水和小肠梗阻（P<.05）。
典型的隐匿性气腹在肝移植术后 2 周后更常偶然发现，但在发病时间和表现方式上，隐匿性和气腹性气腹之间存在一些重叠。在 CT 表现中，严重征象包括小肠受累、肠系膜血管直径变化、门腔静脉积气、内脏梗死、血性腹水和小肠梗阻。
