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Pneumatosis intestinalis in children beyond the neonatal period
K W West1, F J Rescorla, J L Grosfeld
1Department of Surgery, Indiana University Medical Center, Indianapolis.
Insights
Pneumatosis intestinalis (PI) in older children is often associated with underlying conditions and can frequently be managed nonoperatively. Surgical intervention is reserved for severe cases with signs of peritonitis or shock.
Area of Science:
- Pediatric Gastroenterology
- Abdominal Imaging
- Surgical Neonatology
Background:
- Pneumatosis intestinalis (PI) is a known complication of necrotizing enterocolitis (NEC) in neonates, often necessitating surgery.
- Limited data exists on PI in older children and its appropriate management strategies.
Purpose of the Study:
- To investigate the clinical presentation, associated conditions, and management outcomes of pneumatosis intestinalis in older infants and children.
Main Methods:
- Retrospective review of 16 patients (older than 2 months) with radiographic evidence of PI.
- Analysis of clinical data, comorbidities, treatment approaches (operative vs. nonoperative), and patient outcomes.
Main Results:
- Common presentations included abdominal distension and bloody diarrhea.
- Short bowel syndrome was the most frequent comorbidity (8/16 patients).
- Nonoperative management (IV antibiotics, supportive care) was successful in 10/14 patients; surgery was required for those with peritonitis or shock.
Conclusions:
- Pneumatosis intestinalis in older children, while less common than in neonates, can be managed nonoperatively in most cases.
- Early recognition and appropriate supportive care are crucial, with surgery reserved for complicated cases.
Abstract:
Pneumatosis intestinalis (PI) is a well-recognized manifestation of necrotizing enterocolitis (NEC) in the newborn--a condition that often requires surgical intervention for infarcted bowel. However, little information is available concerning PI in older children or its management. Sixteen older infants and children (greater than 2 months) had x-ray findings of PI (intramural air). There were eight girls and eight boys ranging in age from 2 months to 8 years. Associated conditions included short bowel syndrome (SBS) (8), congenital heart disease (2), iron ingestion (1), nesidioblastosis (1), hemolytic anemia (1), rheumatoid arthritis (1), bronchopulmonary dysplasia (BPD) (1), and malrotation (1). Clinical presentation included abdominal distension (13), bloody diarrhea (12), bilious emesis (5), and lethargy (5). Two patients on steroids had unsuspected PI identified as an incidental operative finding during pancreatectomy for nesidioblastosis (1) and splenectomy for hemolytic anemia (1), respectively. Only four other children (iron toxicity, postcardiac catheterization, rheumatoid arthritis, and BPD required surgical intervention. Each manifested peritioneal irritation, acidosis, and hypotension or had pneumoperitoneum on abdominal x-ray. In ten of 14 patients, PI was managed nonoperatively with nasogastric suction, fluid resuscitation, intravenous (IV) antibiotics (seven to ten days), and repeated abdominal x-ray and physical examinations. Children with SBS comprised 50% of the total number of patients and eight of ten treated by observation. All had associated viral syndromes (rotavirus) or rhotozyme-positive stools and developed bloody diarrhea. There were two deaths (12.5%) in patients with iron toxicity and congenital heart disease who required resection of gangrenous bowel. All of the other patients survived.(ABSTRACT TRUNCATED AT 250 WORDS)