Potential extraperitoneal space continuous with the peri-intestinal space: CT evidence and anatomical evaluation in patients with pneumatosis intestinalis without intestinal ischemia

• Published in: Surgical and radiologic anatomy (English ed.) 2009-11, Vol.31 (9), p.707-713
• Main Authors: Katada, Yoshiaki, Isogai, Jun, Ina, Hiroyasu, Tezuka, Mikio, Umehara, Isao, Shibuya, Hitoshi
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Cavity - diagnostic imaging; Adult; Aged; Anatomy; Anatomy & physiology; Biological and medical sciences; Cohort Studies; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Imaging; Intestines - blood supply; Ischemia - diagnostic imaging; Ischemia - pathology; Male; Medical sciences; Medicine; Medicine & Public Health; Mesentery - anatomy & histology; Mesentery - diagnostic imaging; Middle Aged; Original Article; Orthopedics; Other diseases. Semiology; Pneumatosis Cystoides Intestinalis - diagnostic imaging; Pneumatosis Cystoides Intestinalis - pathology; Pneumatosis Cystoides Intestinalis - surgery; Pneumoperitoneum - diagnostic imaging; Pneumoradiography - methods; Radiology; Retroperitoneal Space - anatomy & histology; Retroperitoneal Space - diagnostic imaging; Retrospective Studies; Sensitivity and Specificity; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Tomography; Tomography, X-Ray Computed - methods
• ISSN: 0930-1038; 1279-8517
• DOI: 10.1007/s00276-009-0511-1

Purpose Extraperitoneal spaces, such as the mesenteric space and the retroperitoneal space, can serve as areas that enable a reduction in the pressure exerted by extraperitoneal fluid collection and infiltrating diseases. In clinical practice, understanding the existence of these decompression spaces (or pathways) is very important for making accurate diagnoses. Here, we evaluated potential anatomical extraperitoneal spaces based on the extraluminal gas distribution in patients with pneumatosis intestinalis without intestinal ischemia. Methods The computed tomography scans of ten patients with pneumatosis intestinalis without intestinal ischemia were reviewed, and the anatomic location of the extraluminal gas distribution was investigated. Results Four patients were diagnosed as having pneumatosis intestinalis of the small intestine and six were diagnosed as having pneumatosis intestinalis of the large intestine. Mesenteric pneumatosis was observed in nine (90%) of the ten patients. The potential anatomical extraperitoneal spaces (or decompression pathways) were classified as follows: mesenteric ( n  = 3), retroperitoneal ( n  = 4), and direct ( n  = 5). Conclusions The distributions of the extraluminal gas were classified into three categories, and each location may characterize a different decompression pathway. The existence of a potential extraperitoneal space continuous with the peri-intestinal space was confirmed in living subjects.