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C difficile induced pneumatosis intestinalis in a neutropenic child
  1. P M Gillett1,
  2. R K Russell1,
  3. D C Wilson1,
  4. A E Thomas2
  1. 1Department of Gastroenterology and Nutrition, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, Scotland, UK; peter.gillett{at}luht.scot.nhs.uk
  2. 2Department of Haematology, Royal Hospital for Sick Children

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A 4 year old boy presented with a 24 hour history of fever, cramping central abdominal pain with distension, and bloody diarrhoeal stools. He had developed acute myeloblastic leukaemia at the age of 1. He eventually required a matched unrelated graft which engrafted poorly, and subsequently developed graft versus host disease (GVHD). He was currently neutropenic.

Temperature was 38.5°C, pulse 150/min; he had abdominal distension and tenderness but no ascites.

An abdominal film (fig 1) revealed dilatation of the colon with gaseous linear tramlining of the bowel wall consistent with pneumatosis intestinalis (PI). Stools were positive for Clostridium difficile toxin A. PI resolved with bowel rest, intravenous fluids, meropenem, and metronidazole but he later died of relapsed leukaemia.

PI is described in children in Crohn's disease,1 ulcerative colitis,2 leukaemia,3 trauma,4 HIV,5 and GVHD after BMT.6C difficile, pseudomembranous colitis, and PI are reported in an immunocompetent adult patient.7 Conservative management is usually successful but acidosis and portal gas are associated with a poor outcome.8

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    BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health