Pneumatosis cystoides intestinalis is a special type of pneumatosis intestinalis with benign prognosis but needs to be distinguished from necrotizing pneumatosis intestinalis: a retrospective cohort study

Background: Pneumatosis cystoides intestinalis (PCI) is a special type of pneumatosis intestinalis (PI), however, its clinical features and prognosis distinguished from necrotizing PI (NPI) have not been elucidated sufficiently. Methods Clinical data of patients diagnosed with PCI and NPI from January 2011 to December 2020 in Peking University People's Hospital were reviewed. The clinical characteristics, treatment strategy, and prognosis of PCI and NPI were compared. Results A total of 25 patients diagnosed with PCI and 21 patients diagnosed with NPI were involved in this study. Patients in PCI group were accompanied by lighter inflammatory responses than NPI group. In the CT examination, patients in PCI group were observed with higher proportion of cystic gas (100.0% vs 0.0%, P  < 0.001) and free peritoneal air (68.0% vs 14.3%, P  < 0.001), and lower proportion of peritoneal irritation sign (0.0% vs 61.9%, P  < 0.001), bowel effusion (0.0% vs 66.7%, P  < 0.001) and ascites (0.0% vs 90.5%, P  < 0.001) compared to NPI group. All patients in PCI group were cured after conservative treatment. However, 18 (85.7%) patients in NPI group had enterectomy, and 8 (38.1%) patients died in the hospital. Conclusion PCI is a special type of PI with benign prognosis. Early identification of PCI and differentiation from NPI is the prerequisite to avoid overtreatment.