Management of pneumatosis intestinalis in children over the age of 6 months: a conservative approach

Abstract

PI in children who are not on chemotherapy or immunosuppressant appears to follow a benign course and is responsive to conservative management. In contrast to adults, portal venous gas and pneumoperitoneum do not predict the need for surgical intervention.

Pneumatosis cystoides intestinalis: A rare complication after hematopoietic stem cell transplantation

“…Although patients with PCI are often asymptomatic, diarrhea, intestinal bleeding, distension, and abdominal pain can occur, which may mimic intestinal GVHD clinically. In the study of Nellihella L. et al, 21 abdominal distension was the most common symptom of 33%. Intestinal necrosis and perforation have also been reported in some cases 11 …”

A 9‐year‐old boy with severe motor and intellectual disabilities and prolonged abdominal distension

“…Pneumatosis intestinalis is uncommon after the neonatal period. Associated factors include infection, post‐transplantation, cow's milk allergy, gastrointestinal problems, and medication, whereas children with neurologic impairment or tube feeding have also been reported 3–6 . Flatulence is known as an adverse effect of alpha‐glucosidase inhibitors, which are effective for dumping syndrome; this may lead to pneumatosis intestinalis 7–9 .…”

Pneumatosis Intestinalis in Children With Intestinal Failure: The Result of Intestinal Stress From Enteral Feeding?

“…P neumatosis intestinalis (PI), or submucosal air in the intestinal wall, has been theorized to occur by several mechanisms including increased intraluminal pressure leading to diffusion of gas into intestinal wall layers, dissection of intraluminal gas due to mucosal disruption, translocation of gas-producing bacteria, increased luminal bowel distension leading to bowel wall ischemia, or translocation of air from pulmonary alveolar rupture that travel along the mesenteric vessels to the bowel wall (1). The etiology of PI can be due to a variety of causes including congenital/chromosomal abnormalities, trauma, inflammation, infection, ischemia, and autoimmune/immunosuppressive processes (2,3).…”

“…The etiology of PI can be due to a variety of causes including congenital/chromosomal abnormalities, trauma, inflammation, infection, ischemia, and autoimmune/immunosuppressive processes (2,3). The presence of PI may represent impending intestinal compromise or may be a benign finding with morbidity and mortality dependent upon the underlying etiology and patient comorbidities (1)(2)(3). In premature infants with necrotizing enterocolitis (NEC), PI can be associated with systemic infection, sepsis, and death; however, a significant proportion of PI may be considered benign and might not represent an irreversible ischemic process.…”

“…It is also defined as a "reduction of functional intestinal mass below that which can sustain life, resulting in dependence on supplemental parenteral support for a minimum of 60 days within an interval of 74 consecutive days" (6). PI has been reported previously in the intestinal failure population, but largely in the context of retrospective studies of patients with PI (1,2). The significance of PI in this population is unknown but can pose a clinical dilemma to surgeons as the potential of operative management with bowel resection has even more substantial implications for these children with minimal lengths of remaining or functional bowel.…”