From the Guidelines
Bowel infarction due to mesenteric ischemia is characterized by key X-ray findings including pneumatosis intestinalis, portal venous gas, pneumatosis intestinalis, and lack of bowel wall enhancement, which are indicative of transmural infarction and poor prognosis. These findings are critical in determining the severity of the condition and the need for immediate surgical intervention. According to the American College of Radiology 1, CT findings such as lack of bowel wall enhancement, free intraperitoneal air, pneumatosis intestinalis, and portal venous gas should prompt immediate surgical intervention.
Key X-ray Findings
- Pneumatosis intestinalis (gas within the bowel wall)
- Portal venous gas
- Pneumatosis intestinalis
- Lack of bowel wall enhancement
- Free intraperitoneal air Plain radiographs may show dilated bowel loops with air-fluid levels indicating ileus, and in advanced cases, fixed dilated loops that don't change position over time. Bowel wall thickening may be visible as a hazy density. However, these findings are often subtle in early stages, making them easy to miss. The presence of pneumatosis intestinalis or portal venous gas represents late findings and indicates transmural infarction with poor prognosis.
Diagnostic Imaging
While plain radiographs can detect these changes, they have limited sensitivity, especially early in the disease process. CT imaging is much more sensitive and specific for diagnosing mesenteric ischemia and should be obtained promptly when clinical suspicion exists, as early intervention significantly improves outcomes in this life-threatening condition 1.
From the Research
Key X-ray Findings in Bowel Infarction due to Mesenteric Ischemia
The key X-ray findings in bowel infarction due to mesenteric ischemia include:
- Pneumatosis intestinalis (PI) 2, 3, 4, 5
- Mesenteric or portal venous gas 2, 3, 4, 5
- Focally thick-walled bowel 3
- Focally edematous bowel 3
- Splenic air embolism 4
Diagnostic Techniques
Both computed tomography (CT) scans and plain films can be used to diagnose bowel infarction due to mesenteric ischemia:
- CT scans can identify specific criteria for infarction, such as pneumatosis, mesenteric or portal venous gas, and focally thick-walled bowel 3, 4, 5
- Plain films can provide complementary information and identify specific changes, such as focally edematous bowel and pneumatosis intestinalis 3
Importance of Early Diagnosis
Early diagnosis and intervention are crucial to prevent bowel necrosis and patient death 6 Negative or nonspecific findings on CT or plain films should not deter further diagnostic or interventional procedures in patients with a high clinical suspicion of bowel infarction 3