Pneumatosis Cystoides Intestinalis with Abdominal Free Air in a 2-Year-Old Girl after Allogeneic Bone Marrow Transplantation

Abstract

A 2-year-old girl with acute lymphoblastic leukemia (ALL) showing a t(4;11)(q21;q23) karyotype underwent allogeneic bone marrow transplantation (BMT) with the conditioning regimen of L-PAM (70 mg/m2/d for 3 days), busulfan (140 mg/m2/d for 2 days), and total body irradiation (12 Gy). On day 57, the patient developed pneumatosis cystoides intestinalis (PCI) when she received cyclosporin A and corticosteroids for graft-versus-host disease (GVHD). Because of the presence of massive abdominal free air and the suspicion of peritonitis, she underwent surgical intervention, which, however, revealed neither intestinal perforation nor peritoneal infection. She recovered from PCI in 10 days with nasogastric suction, fasting, and systemic broad-spectrum antibiotics. PCI with massive abdominal free air after BMT should be manageable by conservative therapy alone.

Pneumatosis Cystoides Intestinalis Following Steriod Pulse Therapy in a Patient with Polyarteritis Nodosa

“…Recently, PCI cases that were caused by administration of immunosuppressive agents such as cyclosporine A and cyclophosphamide were also reported and the pathogenesis similar to corticosteroid has been proposed. 18,19 In addition to the oral administration of corticosteroid, the present case was treated with steroid pulse therapy and an additional medication of cyclophosphamide just before the occurence of PCI. This suggests that one or more of these immunosuppressive agents might be a cause of PCI, however it is uncertain which agent caused PCI in this case.…”

Case Report: Massive Intestinal Pneumatosis and Pneumoretroperitoneum Following Hematopoietic Stem Cell Transplantation in a 2-Year-Old Child

“…Conversely, in most cases of IP with associated PP, emergency surgery is mandatory. Although PP associated with IP without peritonitis has been rarely reported in the literature ( 3 , 16 ), the presence of PP is often synonymous with intestinal perforation and peritonitis, which in turn may be the motor for systemic inflammatory reaction syndrome and multiple organ dysfunction.…”

Pediatric Abdominal Infection and Inflammation: Choosing the Appropriate Diagnostic Imaging Study

“…10 Additional known factors for the development of pneumatosis intestinalis include mechanical, bacterial, chemical, dietary, and neoplastic alterations of the gut. [11][12][13][14][15] In the absence of free intraperitoneal air, which is concerning for bowel perforation or ischemia, cases of pneumatosis are managed conservatively with bowel rest and broad-spectrum antibiotics.…”

“…In the setting of suspected uncomplicated musculoskeletal infection, a two-phase or three-phase Tc-99m methylene diphosphonate (MDP) scan of the whole body may succeed in identifying sites of osteomyelitis (►Fig. 14). This scintigraphic study may also distinguish septic arthritis or cellulitis from a bone infection.…”