Pneumatosis intestinalis in children beyond the neonatal period: is it always benign?

Area of Science:

• Pediatric Gastroenterology
• Abdominal Imaging
• Surgical Outcomes

Background:

• Pneumatosis intestinalis (PI) in children beyond the neonatal period lacks clear definition regarding its significance and management.
• Understanding the spectrum of PI is crucial for appropriate clinical decision-making.

Purpose of the Study:

• To clarify the significance and management of pediatric pneumatosis intestinalis (PI) in patients aged 3 months to 18 years.
• To differentiate between benign and pathologic PI and identify associated risk factors.

Main Methods:

• Retrospective study of pediatric patients (3 months–18 years) diagnosed with PI.
• Definition of pathologic PI as irreversible, transmural intestinal ischemia.
• Analysis of clinical presentation, imaging findings, and treatment outcomes.

Main Results:

• 167 children had PI; 92.8% had benign PI, 7.2% had pathologic PI.
• Global developmental delay was common in pathologic PI (75%).
• Abdominal distension, guarding, portal venous gas, and bowel distension were associated with pathologic PI. Only 6.6% required surgery.

Conclusions:

• Pediatric PI is predominantly a benign condition, often managed non-surgically.
• Bowel rest and antibiotics are common therapeutic strategies for benign PI.
• Careful evaluation is needed to identify cases of pathologic PI requiring intervention.