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Pneumatosis intestinalis after hematopoietic stem cell transplantation: When not doing anything is good enough
Gregory Wallace1, Nelson Rosen2, Alexander J Towbin3
1Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; University of Cincinnati, Cincinnati, OH, USA.
Insights
Pneumatosis intestinalis (PI) is common in hematopoietic stem cell transplant (HSCT) recipients on steroids but rarely causes harm. Most patients with PI need only monitoring, not intervention, with surgery based on symptoms, not PI alone.
Area of Science:
- Gastroenterology
- Hematology
- Pediatric Medicine
Background:
- Pneumatosis intestinalis (PI) is a known complication in hematopoietic stem cell transplant (HSCT) recipients.
- There is a lack of consensus regarding the clinical significance and management of PI in this population.
Purpose of the Study:
- To investigate the incidence, clinical presentation, management, and outcomes of pneumatosis intestinalis in pediatric HSCT recipients.
- To clarify the clinical significance of PI in HSCT recipients and guide management strategies.
Main Methods:
- Retrospective review of medical records for 990 pediatric HSCT recipients.
- Analysis of clinical data, diagnostic modalities (primarily abdominal X-ray), management strategies, and patient outcomes related to PI.
Main Results:
- PI was identified in 5.4% of pediatric HSCT recipients, predominantly in those receiving systemic steroids.
- Most PI cases (81%) resolved spontaneously within a median of 15 days without specific intervention.
- Surgical consultation was rarely needed (13%), and no surgical interventions were required, even in patients with pneumoperitoneum.
Conclusions:
- Pneumatosis intestinalis is a frequent finding in HSCT recipients on steroids but generally carries a low clinical risk post-transplant.
- The majority of HSCT recipients with PI can be managed with close monitoring and do not require targeted interventions.
- Surgical evaluation for PI should be guided by clinical symptoms of acute abdomen rather than the mere presence of PI.
Background/Purpose:
Pneumatosis intestinalis (PI) has been reported in hematopoietic stem cell transplant recipients (HSCT) since 1980s and at present there is no uniform consensus of the significance and management of this condition.
Methods:
We retrospectively reviewed medical records of 990 consecutive pediatric HSCT recipients and examined data for clinical PI presentation, management and outcomes RESULTS: PI was identified in 53 patients (5.4%), mainly allogeneic HSCT recipients receiving systemic steroids. Abdominal X-ray was the main diagnostic modality. Forty-seven patients (89%) were evaluated because of clinical concerns and others were identified as incidental findings. Pneumoperitoneum was reported in 15 patients (28%). None of these patients had signs of acute abdomen. The majority of patients (43/53, 81%) had no targeted clinical intervention for PI and resolved PI in a median of 15 days (IQR 3-61). Surgery consult was only requested for 7/53 (13%) patients, three of whom had evidence of pneumoperitoneum. None of these patients required any surgical interventions.
Conclusions:
Pneumatosis intestinalis commonly occurs in HSCT recipient receiving steroids, but unlike with NEC, PI rarely poses clinical risk after transplant. The majority of HSCT recipients with PI require only close monitoring without interventions. Surgical evaluation should be based on clinical symptoms and not PI presence alone.
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