Pneumatosis intestinalis after hematopoietic stem cell transplantation: When not doing anything is good enough

Pneumatosis intestinalis after allogeneic hematopoietic cell transplantation

“…a radiographic finding resulting from an underlying pathology [1,2]. PI can occur as a complication following allogeneic hematopoietic cell transplantation (allo-HCT) in children.…”

“…The risk factors include: conditioning chemotherapy or irradiation, antibiotic exposure, gastrointestinal (GI) infections with Clostridioides difficile or Escherichia coli, GI graftversus-host disease (GvHD), and prolonged immune suppression [1][2][3].…”

“…Pathogenetically, PI occurs as primary (idiopathic) (in 15% of cases) or secondary (in 85% of cases) [1,4]. Clinical symptoms include diarrhea, vomiting, pain, tenderness, and flatulence [1,2]. The diagnosis is usually made by computed tomography (CT), but sometimes it is identified by abdominal X-ray.…”

“…The diagnosis is usually made by computed tomography (CT), but sometimes it is identified by abdominal X-ray. PI is managed conservatively, and surgery is optional in cases of subsequent complications [1][2][3][4].…”

“…Two months later, all CT symptoms from the GI tract had resolved. The probable mechanism of developing PI after allo-HCT is chemotherapy and immunosuppression, which can induce atrophy of the Peyer's patches [2,4]. This can lead to the loss of integrity and focal damage of the bowel mucosa [4].…”