Pneumatosis intestinalis after bone marrow transplantation

Day, Deborah; Ramsay, N. K. C.; Letourneau, J G

doi:10.2214/ajr.151.1.85

Cited by 82 publications

(61 citation statements)

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“…The use of steroids and its association with development of PI, however, has been well-described. 1,3,8,9 The most commonly accepted mechanism is that steroids cause atrophy of the lymphoid tissue (Peyer's patches) in the gastrointestinal tract, which results in mucosal degradation, allowing dissection of intraluminal air into the intestinal wall. Immunosuppression after cardiac transplantation varies by center with some using steroid-free regimens after a variable time posttransplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Concomitant infections including rotavirus and C difficile were seen in 5 of our 8 cases of PI. Both rotavirus 1,3 and C difficile 1,3,7 have been associated with PI. The proposed mechanism for the development of PI with these infectious agents is based on inflammation causing a break in the integrity of the intestinal mucosa, thus allowing intraluminal air to dissect into the bowel wall.…”

Section: Discussionmentioning

confidence: 99%

“…1 Outside the neonatal period, PI is fairly uncommon. It has, however, been associated with a variety of disorders and procedures including solid organ and bone marrow transplantation, [2][3][4][5][6][7][8] steroid and other immunosuppressive medications, 1,3,8,9 ischemia, inflammatory bowel disease, intestinal obstruction, and obstructive airway disease. In addition, several concomitant infectious agents have been associated with the development of PI including cytomegalovirus (CMV), Clostridium difficile, rotavirus, human immunodeficiency virus (HIV), and other viral infectious agents.…”

mentioning

confidence: 99%

“…In addition, several concomitant infectious agents have been associated with the development of PI including cytomegalovirus (CMV), Clostridium difficile, rotavirus, human immunodeficiency virus (HIV), and other viral infectious agents. 3,4,6,7,9 PI may present in a variety of ways, ranging from an incidental finding that is clinically benign to an acute and life-threatening illness. Recently diagnosed cases of PI in our pediatric thoracic organ transplantation population prompted us to retrospectively review this group of patients and evaluate them for significant clinical outcomes as well as potential risk factors in the development of PI.…”

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confidence: 99%

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Pneumatosis Intestinalis After Pediatric Thoracic Organ Transplantation

et al. 2002

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ABSTRACT. Objective. To review and describe pneumatosis intestinalis (PI) in children who have undergone thoracic organ transplantation and evaluate potential risk factors.Methods. We retrospectively reviewed abdominal radiographs obtained from June 1992 through September 2000 in all pediatric (age <21 years) thoracic organ recipients who survived at least 1 week after transplantation. In this group, a case was defined as an episode of radiographically confirmed PI; those without PI were assigned as controls. Variables analyzed included demographic data, gastroenteritis history (stool cultures or symptoms of gastroenteritis), and transplant-related factors (ie, graft type, rejection history, immunosuppression regimen). Significance was defined as P < .05.Results. Over this 8-year period, PI occurred in 8 (7%) of 116 patients (0.86% annual risk). No child had >1 diagnosed episode of PI. Of these 8 cases, 7 presented with 1 or more abdominal symptoms. Three of these children had rotavirus antigen isolated in their stool, 2 others were noted to have stool positive for Clostridium difficile toxin, and in the other 3, no pathogen was identified. All cases were treated with a regimen of intravenous antibiotics and total parenteral nutrition. There were no deaths; however, 1 patient developed an Aspergillus pulmonary infection during his course of antibiotic therapy, and another underwent an exploratory laparotomy without bowel resection. Significant risk factors included black race (unadjusted odds ratio: 16), younger age at presentation (age <5 years; unadjusted odds ratio: 9), higher steroid dose (steroid dose >0.5 mg/kg/d; unadjusted odds ratio: 7), and a higher tacrolimus level at presentation (tacrolimus level >1; unadjusted odds ratio: 6). PI did not occur with a steroid dose <0.4 mg/kg/d. Variables not associated with increased risk for developing PI included gender, graft type, total white blood cell count, recent antibiotic use, concurrent use of an antimetabolite, cytomegaloviral infection, past use of extracorporeal membrane oxygenation, and graft rejection history.Conclusions. Significant risk factors for the development of PI in our pediatric thoracic organ transplantation population included black race, younger age, higher daily steroid dosing, and a high tacrolimus level at presentation. In the children diagnosed with PI, there were no related deaths, significant gastrointestinal sequelae, or complications. These findings suggest that in this population, PI will often have a benign course when treated aggressively, and that steroid dosing should be reduced to <0.5 mg/kg/d whenever possible. Pediatrics 2002;109(5). URL: http://www.pediatrics.org/cgi/content/ full/109/5/e78; pediatric heart transplantation, pediatric lung transplantation, pediatric heart-lung transplantation, pneumatosis intestinalis, steroids.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

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Pneumatosis Intestinalis After Pediatric Thoracic Organ Transplantation

et al. 2002

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“…19 In this case series, steroids were used in combination with other immunosuppressive therapy primarily the calcineurin inhibitors cyclosporine and tacrolimus. Glucocorticoid therapy alone appears to increase significantly the risk of PI development.…”

Section: Discussionmentioning

confidence: 99%

Medical management of pneumatosis intestinalis in patients undergoing allogeneic blood and marrow transplantation

Hepgur

Ahluwalia

Anne

et al. 2010

Bone Marrow Transplant

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The Spectrum of Pneumatosis Intestinalis

Peter¹

2003

Arch Surg

359

362

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A review of the spectrum of illness associated with pneumatosis intestinalis enables us to identify the probable causes of, the best diagnostic approaches to, and the most appropriate treatments for this condition. Data Sources: A review of all published material in the English language regarding pneumatosis intestinalis was conducted using the PubMed and MEDLINE databases. Any relevant work referenced in those articles and not previously found or published before the limit of the search engine was also retrieved and reviewed.Study Selection: There were no exclusion criteria for published information relevant to the topic. All of the studies cited in the present review make a point that contributes to the portrayal of this condition. In circumstances in which the same point was made in several different studies, not all were cited herein.Data Extraction: All published material on pneumatosis intestinalis was considered. Information was extracted for preferentially selected ideas and theories supported in multiple studies.Data Synthesis: The collected information was organized by theory.Conclusions: Mucosal integrity, intraluminal pressure, bacterial flora, and intraluminal gas all interact in the formation of pneumatosis intestinalis. Radiography and computed tomography are the best diagnostic tests. Nonoperative management should be pursued in most patients, and underlying illnesses should be treated. When acute complications appear, such as perforation, peritonitis, and necrotic bowel, surgery is indicated.

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Pneumatosis intestinalis after bone marrow transplantation

Cited by 82 publications

References 10 publications

Pneumatosis Intestinalis After Pediatric Thoracic Organ Transplantation

Pneumatosis Intestinalis After Pediatric Thoracic Organ Transplantation

Medical management of pneumatosis intestinalis in patients undergoing allogeneic blood and marrow transplantation

The Spectrum of Pneumatosis Intestinalis

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