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Cecal Pneumatosis in Patients with Obstructive Colon Cancer: Correlation of CT Findings with Bowel Viability

Patrice Taourel1, Fabrice Garibaldi1, Jerome Arrigoni1, Virginie Le Guen1, Alvian Lesnik1 and Jean Michel Bruel2

1 Department of Radiology, Lapeyronie Hospital, 371, avenue du Doyen Gaston Giraud, 34295, Montpellier cedex 5, France.
2 Department of Radiology, Saint-Eloi Hospital, Montpellier, France.



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  		Fig. 1A. —Cecal pneumatosis in 70-year-old man. CT scans obtained with standard abdominal (A) and wider (B) window settings show small gas bubbles in cecal wall. Bubbles raise air–fluid levels. Findings at surgery and pathologic examination showed cecal transmural necrosis. Note also fluid lateral relative to ascending colon.

 


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  		Fig. 1B. —Cecal pneumatosis in 70-year-old man. CT scans obtained with standard abdominal (A) and wider (B) window settings show small gas bubbles in cecal wall. Bubbles raise air–fluid levels. Findings at surgery and pathologic examination showed cecal transmural necrosis. Note also fluid lateral relative to ascending colon.

 


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  		Fig. 2A. —Cecal pseudopneumatosis in 76-year-old man. Standard abdominal (A) and wider (B) window settings show tiny gas bubbles in periphery of lumen contiguous to colonic wall. Bubbles do not raise air–fluid levels. Surgery did not reveal cecal necrosis.

 


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  		Fig. 2B. —Cecal pseudopneumatosis in 76-year-old man. Standard abdominal (A) and wider (B) window settings show tiny gas bubbles in periphery of lumen contiguous to colonic wall. Bubbles do not raise air–fluid levels. Surgery did not reveal cecal necrosis.

 


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  		Fig. 3A. —83-year-old man with occlusive sigmoid cancer and pneumatosis. CT scan shows occlusive sigmoid cancer (arrow).

 


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  		Fig. 3B. —83-year-old man with occlusive sigmoid cancer and pneumatosis. CT scans of cecum obtained with standard abdominal (B) and wider (C) window settings show curvilinear pneumatosis. Note also huge pneumoperitoneum. Findings at surgery and pathology confirmed necrosis of cecum.

 


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  		Fig. 3C. —83-year-old man with occlusive sigmoid cancer and pneumatosis. CT scans of cecum obtained with standard abdominal (B) and wider (C) window settings show curvilinear pneumatosis. Note also huge pneumoperitoneum. Findings at surgery and pathology confirmed necrosis of cecum.

 


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  		Fig. 4A. — 65-year-old man with occlusive sigmoid cancer and pneumatosis. Axial CT scan (A) and sagittal reformatted image (B) show occlusive sigmoid cancer (arrow).

 


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  		Fig. 4B. — 65-year-old man with occlusive sigmoid cancer and pneumatosis. Axial CT scan (A) and sagittal reformatted image (B) show occlusive sigmoid cancer (arrow).

 


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  		Fig. 4C. — 65-year-old man with occlusive sigmoid cancer and pneumatosis. CT scans obtained with standard abdominal (C) and wider (D) window settings show bubbly pneumatosis in cecal wall. Surgery did not reveal any findings of ischemia or necrosis of cecum.

 


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  		Fig. 4D. — 65-year-old man with occlusive sigmoid cancer and pneumatosis. CT scans obtained with standard abdominal (C) and wider (D) window settings show bubbly pneumatosis in cecal wall. Surgery did not reveal any findings of ischemia or necrosis of cecum.

 

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