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Resource utilization and surgical risk in pediatric pneumatosis intestinalis
Shachi Srivatsa1, Megan Read2, Taha Akbar3
1Center for Surgical Outcomes and Research, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Insights
Surgery for pediatric pneumatosis intestinalis (PI), excluding necrotizing enterocolitis (NEC), is uncommon. Key indicators for potential surgery include colonic PI, fever, tachycardia, and significant comorbidities, guiding treatment decisions.
Area of Science:
- Pediatric Gastroenterology
- Surgical Pediatrics
- Medical Imaging
Background:
- Pneumatosis intestinalis (PI) in children, excluding necrotizing enterocolitis (NEC), is typically managed non-operatively.
- Limited guidance exists for estimating surgical risk in non-NEC PI, complicating treatment duration decisions.
Purpose of the Study:
- To assess the management of non-NEC PI in children.
- To identify factors associated with the need for surgical intervention in these cases.
Main Methods:
- Retrospective review of pediatric patients (6 months-21 years) diagnosed with PI between 2010-2023.
- Exclusion of patients with recent NEC or abdominal surgery.
- Analysis of clinical data, imaging findings, and management strategies.
Main Results:
- 102 patients (139 encounters) were included; 3.6% required surgery.
- Surgical intervention was linked to colonic PI, fever, tachycardia, and complex comorbidities.
- Most cases resolved with non-operative management including antibiotics and gastric decompression.
Conclusions:
- Surgery for non-NEC pediatric PI is rare and associated with specific clinical and radiological features.
- Identifying high-risk indicators can aid in optimizing treatment duration and resource allocation.
- Non-operative management is effective for the majority of pediatric non-NEC PI cases.
Introduction:
Pneumatosis intestinalis (PI) in children, excluding necrotizing enterocolitis (NEC), is typically managed non-operatively with bowel rest, antibiotics, and total parenteral nutrition (TPN). However, guidance is limited on estimating the risk of requiring surgery, complicating decisions about the duration of non-operative medical treatment. This study aimed to assess the management of non-NEC PI and identify factors associated with surgical intervention.
Methods:
A retrospective review was conducted of patients aged 6 months to 21 years diagnosed with PI from 2010 to 2023 at a free-standing children's hospital. Patients with NEC in the prior six months or abdominal surgery in the preceding three months were excluded.
Results:
102 patients (139 encounters) met inclusion criteria. Median age was 4.5 years; 29 % had genetic disorders, 22 % malignancies (17 on active treatment), and 13 % congenital heart disease. PI was identified via plain radiograph (71 %), CT (25 %), or both (4 %). In 16.5 % of cases, PI was an incidental finding. Antibiotics were used in 91 % of encounters and gastric decompression in 83 %. Surgery was required in 5 patients (3.6 %) due to radiologic progression (100 %), worsening pain/distention (100 %), fevers (60 %), and tachycardia (60 %). All surgical cases involved colonic PI and complex comorbidities. Four patients underwent bowel resection; two had colonic necrosis, and two had resections for underlying motility disorders.
Conclusion:
Surgery for non-NEC pediatric PI was rare and associated with colonic involvement, fever, tachycardia, and comorbidities. Most cases resolved with a brief course of medical management. Identifying high-risk features may help reduce unnecessary treatment in low-risk patients.
Level Of Evidence:
III.
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