Acute abdomen after oesophago-gastric cancer resection secondary to ‘pneumatosis intestinalis’: an appraisal of this infrequent post-surgical complication

Aim: Pneumatosis intestinal is (PI) is a radiological finding that usually portends untoward outcomes and often warrant aggressive surgical interventions, as it could signify ischaemia. When it occurs as a post-operative complication of surgery, it creates a management dilemma. Our aim was to assess the clinical outcomes of conservatively managed post-operative pneumatosis following upper gastrointestinal (UGI) cancer resection in a tertiary Upper GI cancer centre. Methods: Patients who developed an acute abdomen and had a computed tomography (CT) diagnosis of PI following an UGI cancer resection, between 2008 and 2016 were identified. We analysed contributing factors and clinical outcomes of its operative and non-operative management. Results: Of 717 oesophagogastric resections in the eight-year period, there were nine (1.25%) patients with pneumatosis. Four had oesophageal cancer and five had gastric adenocarcinomas. Four had two-stage oesophagectomies, two had sub-total gastrectomies, two had total gastrectomies and one was attempted resection inoperable. All had jejunostomy feeding tubes (JFT) and four had neo-adjuvant chemotherapy. Post-operatively, CT scans revealed six patients with small bowel pneumatosis, two with colonic pneumatosis, and one had pneumatosis in both small and large bowels. Of the six patients with small bowel pneumatosis, two had portal venous gas and one each occurred at the site of JFT insertion and at the jejuno-jejunal anastomosis. Eight patients recovered from PI with three needing re-operations and 1 died within 24 hrs with PI and acute coronary syndrome. Conclusion: PI is an uncommon complication and can manifest as acute abdomen following UGI cancer resections. Most patients can be managed conservatively when carefully selected and assessed.