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Pneumatosis Intestinalis in Children With Intestinal Failure: The Result of Intestinal Stress From Enteral Feeding?
Marina L Reppucci1, Margo M Nolan2, Emily Cooper3
1From the Department of Surgery, The Mount Sinai Hospital, New York, NY.
Insights
Pneumatosis intestinalis (PI) in children with intestinal failure is often benign. It is linked to enteral feeding, not underlying anatomy, and may indicate increased intestinal stress.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Surgery
- Abdominal Imaging
Background:
- Pneumatosis intestinalis (PI) is gas in the bowel wall, a finding with variable significance in pediatric patients.
- Its incidence and clinical implications in children with intestinal failure are not well-defined.
- Understanding factors associated with PI is crucial for appropriate management in this vulnerable population.
Purpose of the Study:
- To investigate the incidence of PI in pediatric patients diagnosed with intestinal failure.
- To identify clinical and anatomical factors associated with the presence of PI in this cohort.
- To determine the significance and potential causes of PI in children with intestinal failure.
Main Methods:
- Retrospective review of pediatric patients with intestinal failure at a single institution (January 2019 - April 2022).
- Stratification and comparison of patients based on the occurrence of PI on abdominal imaging.
- Statistical analysis using Wilcoxon tests, chi-square, or Fisher exact tests to compare groups.
Main Results:
- 30.6% of 111 pediatric intestinal failure patients developed PI.
- No differences in intestinal failure etiology or anatomy were found between patients with and without PI.
- Patients with PI were less likely on total parenteral nutrition (TPN) and more likely receiving enteral or tube feeds, especially during feed advancement.
Conclusions:
- Pneumatosis intestinalis in children with intestinal failure appears to be a generally benign finding.
- Its development is associated with enteral nutrition, suggesting a link to intestinal stress.
- Further research into the precise mechanisms and management is warranted.
Objective:
The incidence and significance of pneumatosis intestinalis (PI) in children with a diagnosis of intestinal failure is not well understood. The aim of this study was to identify clinical and anatomical factors associated with the imaging findings of PI in patients with intestinal failure.
Methods:
We performed a retrospective review of all children with a diagnosis of intestinal failure at Children's Hospital Colorado between January 2019 and April 2022. Patients were stratified and compared based on the incidence of PI on abdominal imaging. Differences were compared using 2-sample Wilcoxon tests, chi-square, or Fisher exact tests.
Results:
There were 111 patients identified with a diagnosis of intestinal failure and 30.6% (34) developed at least 1 instance of PI. There were no differences in etiology of intestinal failure or anatomy between those who developed PI and those who did not. Patients who developed PI, were less likely to be on total parental nutrition (60.6% vs 98.6%, P < 0.001) and more likely to be receiving any form of enteral feeds (87.9% vs 66.2%, P = 0.035) or tube feeds (75.8% vs 44.2%, P = 0.0045). Of the children with PI, 30.3% (10) were undergoing an enteral feed advancement at time of PI development. Three patients with PI underwent laparotomy for PI treatment, 2 of which were negative laparotomies.
Conclusions:
The development of PI in children with intestinal failure is likely a benign finding. It is associated with enteral feeding and may be due to increased intestinal stress.
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