scholarly journals A Case of Idiopathic Pneumoperitoneum Suspected to Be Caused by Pneumatosis Intestinalis

2021 ◽  
Vol 70 (2) ◽  
pp. 150-155
Author(s):  
Wataru ADACHI ◽  
Jiro IMURA ◽  
Hideki SHIOZAWA ◽  
Yoshiaki HABA
Keyword(s):  
Pneumatosis Intestinalis

scholarly journals 3132 Machine Learning for Prediction of Pathologic Pneumatosis Intestinalis Using CT Scans

2019 ◽  
Vol 3 (s1) ◽  
pp. 60-61
Author(s):  
Kadie Clancy ◽  
Esmaeel Dadashzadeh ◽  
Christof Kaltenmeier ◽  
JB Moses ◽  
Shandong Wu
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Pneumatosis Intestinalis ◽  
Learning Models ◽  
Surgical Decision ◽  
Prediction Task ◽  
Svm Model ◽  
Surgical Decision Making ◽  
Intraoperative Visualization ◽  
Machine Learning Models

OBJECTIVES/SPECIFIC AIMS: This retrospective study aims to create and train machine learning models using a radiomic-based feature extraction method for two classification tasks: benign vs. pathologic PI and operation of benefit vs. operation not needed. The long-term goal of our study is to build a computerized model that incorporates both radiomic features and critical non-imaging clinical factors to improve current surgical decision-making when managing PI patients. METHODS/STUDY POPULATION: Searched radiology reports from 2010-2012 via the UPMC MARS Database for reports containing the term “pneumatosis” (subsequently accounting for negations and age restrictions). Our inclusion criteria included: patient age 18 or older, clinical data available at time of CT diagnosis, and PI visualized on manual review of imaging. Cases with intra-abdominal free air were excluded. Collected CT imaging data and an additional 149 clinical data elements per patient for a total of 75 PI cases. Data collection of an additional 225 patients is ongoing. We trained models for two clinically-relevant prediction tasks. The first (referred to as prediction task 1) classifies between benign and pathologic PI. Benign PI is defined as either lack of intraoperative visualization of transmural intestinal necrosis or successful non-operative management until discharge. Pathologic PI is defined as either intraoperative visualization of transmural PI or withdrawal of care and subsequent death during hospitalization. The distribution of data samples for prediction task 1 is 47 benign cases and 38 pathologic cases. The second (referred to as prediction task 2) classifies between whether the patient benefitted from an operation or not. “Operation of benefit” is defined as patients with PI, be it transmural or simply mucosal, who benefited from an operation. “Operation not needed” is defined as patients who were safely discharged without an operation or patients who had an operation, but nothing was found. The distribution of data samples for prediction task 2 is 37 operation not needed cases and 38 operation of benefit cases. An experienced surgical resident from UPMC manually segmented 3D PI ROIs from the CT scans (5 mm Axial cut) for each case. The most concerning ~10-15 cm segment of bowel for necrosis with a 1 cm margin was selected. A total of 7 slices per patient were segmented for consistency. For both prediction task 1 and prediction task 2, we independently completed the following procedure for testing and training: 1.) Extracted radiomic features from the 3D PI ROIs that resulted in 99 total features. 2.) Used LASSO feature selection to determine the subset of the original 99 features that are most significant for performance of the prediction task. 3.) Used leave-one-out cross-validation for testing and training to account for the small dataset size in our preliminary analysis. Implemented and trained several machine learning models (AdaBoost, SVM, and Naive Bayes). 4.) Evaluated the trained models in terms of AUC and Accuracy and determined the ideal model structure based on these performance metrics. RESULTS/ANTICIPATED RESULTS: Prediction Task 1: The top-performing model for this task was an SVM model trained using 19 features. This model had an AUC of 0.79 and an accuracy of 75%. Prediction Task 2: The top-performing model for this task was an SVM model trained using 28 features. This model had an AUC of 0.74 and an accuracy of 64%. DISCUSSION/SIGNIFICANCE OF IMPACT: To the best of our knowledge, this is the first study to use radiomic-based machine learning models for the prediction of tissue ischemia, specifically intestinal ischemia in the setting of PI. In this preliminary study, which serves as a proof of concept, the performance of our models has demonstrated the potential of machine learning based only on radiomic imaging features to have discriminative power for surgical decision-making problems. While many non-imaging-related clinical factors play a role in the gestalt of clinical decision making when PI presents, we have presented radiomic-based models that may augment this decision-making process, especially for more difficult cases when clinical features indicating acute abdomen are absent. It should be noted that prediction task 2, whether or not a patient presenting with PI would benefit from an operation, has lower performance than prediction task 1 and is also a more challenging task for physicians in real clinical environments. While our results are promising and demonstrate potential, we are currently working to increase our dataset to 300 patients to further train and assess our models. References DuBose, Joseph J., et al. “Pneumatosis Intestinalis Predictive Evaluation Study (PIPES): a multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma.” Journal of Trauma and Acute Care Surgery 75.1 (2013): 15-23. Knechtle, Stuart J., Andrew M. Davidoff, and Reed P. Rice. “Pneumatosis intestinalis. Surgical management and clinical outcome.” Annals of Surgery 212.2 (1990): 160.

scholarly journals Pneumatosis intestinalis in a radioactive iodine-refractory metastasic thyroid papillary carcinoma with BRAFV600E mutation treated with dabrafenib–trametinib: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
M. C. Martín-Soberón ◽  
S. Ruiz ◽  
G. De Velasco ◽  
R. Yarza ◽  
A. Carretero ◽  
...  
Keyword(s):  
Case Report ◽  
Papillary Carcinoma ◽  
Radioactive Iodine ◽  
Specific Treatment ◽  
Pneumatosis Intestinalis ◽  
Thyroid Papillary Carcinoma ◽  
Intestinal Pneumatosis ◽  
Abdominal Symptoms ◽  
Positron Emission ◽  
Thyroid Papillary

Abstract Background Pneumatosis intestinalis (PI) is a rare entity which refers to the presence of gas within the wall of the small bowel or colon which is a radiographic sign. The etiology and clinical presentation are variable. Patients with PI may present either with chronic mild non-specific symptoms or with acute abdominal pain with peritonitis. Some cases of intestinal pneumatosis have been reported as adverse events of new oncological treatments such as targeted therapies that are widely used in multiple tumors. Case presentation A 59-year-old caucasian female with radioactive iodine-refractory metastatic thyroid papillary carcinoma with BRAFV600E mutation was treated with dabrafenib and trametinib as a compassionate use. After 4 months treatment, positron emission tomography–computed tomography (PET–CT) showed PI. At the time of diagnosis, the patient was asymptomatic without signs of peritonitis. The initial treatment was conservative and no specific treatment for PI was needed. Unfortunately, after dabrafenib–trametinib withdrawal, the patient developed tumor progression with significant clinical worsening. Conclusions This case report is, in our knowledge, the first description of PI in a patient treated with dabrafenib–trametinib. Conservative treatment is feasible if there are no abdominal symptoms.

scholarly journals A rare case of emphysematous pyelonephritis associated with pneumatosis intestinalis and bowel ischemia

2021 ◽  
Vol 38 ◽  
pp. 101685
Author(s):  
Albara Hariri ◽  
Abdulhkam Aljarbou ◽  
Khalid Albalawi ◽  
Saad Alqasem ◽  
Ibrahim Alowidah ◽  
...  
Keyword(s):  
Rare Case ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Emphysematous Pyelonephritis

scholarly journals Benign pneumatosis intestinalis with pneumoperitoneum and typhlitis: side-effects of drug or disease induced immunosuppression

2011 ◽  
Vol 2011 (sep13 1) ◽  
pp. bcr0720114518-bcr0720114518 ◽  
Author(s):  
N. J. Wright ◽  
T. Wiggins ◽  
B. M. Stubbs ◽  
A. Engledow
Keyword(s):  
Side Effects ◽  
Pneumatosis Intestinalis

scholarly journals Benign pneumatosis intestinalis: a cause of massive pneumoperitoneum in the adult

CJEM ◽  
2003 ◽  
Vol 5 (06) ◽  
pp. 416-420 ◽  
Author(s):  
David M. Liu ◽  
William C. Torreggiani ◽  
Kevin Rowan ◽  
Savvas Nicolaou
Keyword(s):  
Bowel Wall ◽  
Surgical Intervention ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Benign Condition ◽  
Distinguishing Features

ABSTRACT Pneumatosis intestinalis (gas in the bowel wall) is often a benign condition, but it may mimic bowel ischemia or infarction and lead to unnecessary surgical intervention, especially when associated with pneumoperitoneum. We present a case of benign pneumatosis intestinalis with massive pneumoperitoneum and discuss various distinguishing features that may aid in its diagnosis.

PNEUMATOSIS INTESTINALIS

PEDIATRICS ◽  
1951 ◽  
Vol 7 (4) ◽  
pp. 537-549
Author(s):  
ELLEN P. MACKENZIE
Keyword(s):  
Respiratory Disease ◽  
Clinical Diagnosis ◽  
General Condition ◽  
Clinical Picture ◽  
Pediatric Patients ◽  
Pneumatosis Intestinalis ◽  
Pediatric Age ◽  
Infantile Diarrhea ◽  
Age Range

Thirteen cases of pneumatosis intestinalis are reported, 12 of them in infants between 12 days and 12 months of age, one in a boy of 6 years. Review of these cases and of 32 reported cases falling within the pediatric age range discloses that the disease occurs most frequently in patients whose general condition is poor, that it is very often associated with congenital or acquired disease of the intestine, and that respiratory disease, usually infectious, frequently co-exists. The presence of pneumatosis in pediatric patients has so far been discovered only at autopsy, but clinical diagnosis, with the aid of the typical roentgenologic findings, is feasible and may be accomplished when the disease is more widely known. The clinical picture and roentgenographic findings in adults are reviewed. The most acceptable theories concerning the pathogenesis are discussed, with their possible relation to infantile diarrhea.

Clinical Predictors and Outcomes for Recurrent Pneumatosis Intestinalis in Children

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Allison De Groot Ta ◽  
Michael Farrell ◽  
Jonathan R. Dillman ◽  
Andrew T. Trout
Keyword(s):  
Pneumatosis Intestinalis ◽  
Clinical Predictors
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