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Free air intraperitoneally during chemotherapy for acute lymphoblastic leukemia: consider pneumatosis cystoides

Ellis Groninger1, Jan B F Hulscher, Bert Timmer

  • 1Department of Pediatric Oncology/Hematology of the Beatrix Children's Hospital, University of Groningen, The Netherlands. E.Groninger@ozg.eu

Journal of Pediatric Hematology/Oncology
|February 12, 2010
PubMed

Insights

Pneumatosis cystoides intestinalis (PCI) with free intraperitoneal air can occur in children with acute lymphoblastic leukemia (ALL) without bowel perforation. This case highlights a rare finding in ALL induction therapy for a child with Down syndrome.

Area of Science:

  • Pediatric Oncology
  • Gastroenterology
  • Medical Imaging

Background:

  • Intraperitoneal free air in children undergoing induction chemotherapy for acute lymphoblastic leukemia (ALL) typically suggests gastrointestinal perforation.
  • Pneumatosis cystoides intestinalis (PCI) is a condition characterized by gas-filled cysts in the bowel wall, which can lead to pneumoperitoneum.

Observation:

  • A case of a child with Down syndrome and ALL is presented, who developed pneumoperitoneum during induction chemotherapy.
  • Imaging revealed pneumatosis cystoides intestinalis (PCI) as the cause of free intraperitoneal air.

Findings:

  • The child with PCI and pneumoperitoneum did not have a bowel perforation, despite the presence of free air.
  • This finding is unusual in the context of ALL induction chemotherapy, where free air usually indicates perforation.

Implications:

  • This case underscores the importance of considering PCI as a differential diagnosis for pneumoperitoneum in pediatric ALL patients, especially those with Down syndrome.
  • Management strategies for PCI in this specific patient population require careful consideration of the underlying ALL treatment.
  • Further research into the pathogenesis and optimal management of PCI during ALL induction chemotherapy is warranted.

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