Pneumatosis intestinalis after liver transplantation

Abstract Purpose 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. Materials and methods 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. Results 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). Conclusion 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.