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[Intestinal pneumatosis in pediatrics. Report of 72 cases]
Insights
Pneumatosis intestinalis, a condition affecting the bowel wall, is most common in infants under six months. Early diagnosis and appropriate management, including bowel rest and nutritional support, are crucial for improving patient outcomes.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
Background:
- Pneumatosis intestinalis is a rare condition characterized by gas within the intestinal wall.
- Its incidence and associated conditions vary significantly with age in pediatric populations.
Purpose of the Study:
- To analyze the incidence, clinical associations, diagnostic methods, and pathophysiology of pneumatosis intestinalis in children.
- To evaluate the long-term outcomes and mortality associated with this condition.
Main Methods:
- Retrospective analysis of 72 pediatric cases of pneumatosis intestinalis over a 32-year period.
- Review of diagnostic modalities, primarily radiology, and correlation with clinical presentation and surgical findings.
Main Results:
- Highest incidence observed in children under 6 months of age.
- Neonatal cases frequently associated with necrotizing enterocolitis; older children linked to gastroenteritis.
- Radiology achieved a 93% diagnostic accuracy; 7% diagnosed intraoperatively.
- Proposed pathophysiology involves mucosal integrity disruption and increased intraluminal gas pressure.
Conclusions:
- Early diagnosis of pneumatosis intestinalis is paramount for favorable prognosis.
- Effective management of complications and appropriate intestinal rest with nutritional support are essential.
- Historical data collection contributed to a higher observed mortality rate.
Abstract:
We analyzed 72 cases of pneumatosis intestinalis at the Hospital Infantil de México during a 32 years period. We found the higehst incidence in children under 6 months of age. In the new-born period, the entity is associated with necrotizing entrocolitis and in the older children group, this alteration is associated with gastroenteritis. The diagnosis was made by radiology in 93% of the cases and in 7%, it was made at the surgical event. We propose 3 mechanisms in the pathophysiology of the entity having all of them disruption of the integrity of the intestinal mucosa and higher pressure of the intraluminal gas. The mortality rate was high because we included cases from the initiation of the hospital's activities (1943). The conclusion is: 1) The prognosis is based on an early diagnosis. 2) It is imperative to take proper care of the complication. 3) It is also very important to give a rest for variable period of time to the injured intestine with parenteral feeding and eventually, elemental feeding.