Patient selection: adult with pneumatosis intestinalis
Parameters:
(1) clinical signs of obstruction (nausea, vomiting, abdominal pain)
(2) white blood cell count
(3) age of the patient in years
(4) portal vein gas (PVG) seen on abdominal CT
(5) evidence of sepsis
(6) evidence of acidosis (arterial plasma lactate > 2 mmol/L, arterial pH < 7.3, serum bicarbonate <= 20 mmol/L)
(7) diagnosis (primary bowel problem or not)
(8) surgical candidate
Indications for surgery:
(1) clinical signs of obstruction
(2) WBC > 12,000 per µL
(3) portal vein gas on CT
(4) age >= 60 years
(5) (sepsis or acidosis) AND (primary bowel problem) AND (surgical candidate)
where:
• Surgery was recommended if there was 1 or more of items 1, 2 or 3, especially if the patient was >= 60 years. In the implementation the sum of items 1 to 4 >= 2 would be a definite indication and a sum of 1 to 3 =1 would be a probable.
Indications for medical management:
(1) (does not meet indications for surgery) AND (sepsis or acidosis)
Indications for observation:
(1) (does not meet indications for surgery) AND NOT(sepsis or acidosis)
