The International Journal of Medical Science and Health Research
CT imaging predictors of pathologic pneumatosis intestinalis: A systematic review and meta-analysis
By Harry Nugraha and Achmad Vidiansyah.
Abstract
Introduction
Pneumatosis intestinalis (PI) is a computed tomography (CT) sign rather than a diagnosis, and it spans a spectrum from incidental benign gas to transmural bowel ischaemia and necrosis. Inappropriate interpretation leads either to delayed surgery for necrotic bowel or to non-therapeutic laparotomy. This review aimed to identify and quantify the abdominal CT findings that discriminate pathologic (life-threatening) PI from benign PI.
Methods
The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Randomized controlled trials, prospective and retrospective cohort, case–control and cross-sectional studies of patients with CT-detected PI that compared CT findings between pathologic PI (transmural ischaemia/necrosis at surgery, pathology or autopsy, PI-related death, or study-defined life-threatening PI) and benign PI were eligible. Risk of bias was assessed with the Quality In Prognosis Studies (QUIPS) tool and the Newcastle–Ottawa Scale. Odds ratios (OR) were pooled with DerSimonian–Laird random-effects models, with Hartung–Knapp–Sidik–Jonkman, subgroup, leave-one-out and cumulative analyses; small-study effects were examined with funnel plots, Egger and Begg tests and Doi plots. Certainty was rated with GRADE for prognostic factors.