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Management of Pneumatosis Intestinalis in a Pediatric Burn Patient

Kyle J Kalkwarf1, Richard D Betzold, Stephanie Y Hung

  • 1From the Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Journal of Burn Care & Research : Official Publication of the American Burn Association
|November 8, 2014
PubMed

Insights

Pneumatosis intestinalis, or gas in the gastrointestinal tract wall, is uncommon in pediatric burn patients. This case study details its management and resolution in a young child with severe burns and inhalational injury.

Area of Science:

  • Gastroenterology
  • Pediatric Surgery
  • Burn Medicine

Background:

  • Pneumatosis intestinalis (PI) is characterized by gas within the gastrointestinal tract wall.
  • Its occurrence in pediatric burn patients is infrequently documented.
  • Severe burns and inhalational injuries pose significant risks to pediatric patients, potentially leading to gastrointestinal complications.

Observation:

  • A 23-month-old female sustained extensive deep-partial and full-thickness burns (40% TBSA) with a grade two inhalational injury.
  • Radiographic imaging on postburn day two revealed extensive pneumatosis of the colon.
  • The patient presented with a rare case of pediatric burn-associated pneumatosis intestinalis.

Findings:

  • Conservative management including bowel rest, broad-spectrum antibiotics, and parenteral nutrition led to radiographic resolution of PI.
  • Enteral feeding was successfully reintroduced after PI resolution.
  • The patient developed a post-burn abscess and colocutaneous fistula, which resolved with percutaneous drainage and conservative measures.

Implications:

  • This case highlights that pneumatosis intestinalis in pediatric burn patients can be managed non-operatively.
  • Conservative management may prevent the need for exploratory laparotomy and potential bowel resection in select cases.
  • Early recognition and appropriate supportive care are crucial for managing gastrointestinal complications in severely burned children.

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