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Management of pneumatosis intestinalis in children over the age of 6 months: a conservative approach
  1. Leel Nellihela1,
  2. Mohamed Mutalib2,
  3. David Thompson1,
  4. Kammermeier Jochen2,
  5. Manasvi Upadhyaya1
  1. 1Department of Paediatric Surgery, Evelina London Children’s Hospital, London, UK
  2. 2Department of Paediatric Gastroenterology, Evelina London Children’s Hospital, London, UK
  1. Correspondence to Dr Mohamed Mutalib, Department of Paediatric Gastroenterologist, Evelina London Children’s Hospital, London SE1 7EH, UK; mohamed.mutalib{at}gstt.nhs.uk

Abstract

Background Pneumatosis intestinalis (PI) is an uncommon and poorly understood condition. Although it can be an incidental finding in asymptomatic individuals, it can also be secondary to life-threatening bowel ischaemia and sepsis. In premature infants, it is a pathognomonic sign of necrotising enterocolitis. There is no consensus regarding management and long-term outcome of children with PI.

Aim Review of our experience of PI in children beyond the early infantile period.

Methods Retrospective review of patient’s records and radiological images from 2013 to 2015.

Results Eighteen patients (three girls) had radiologically confirmed PI. The median age was 4.5 years (range 8 months–13 years). Background medical conditions (number): short bowel syndrome (one), congenital heart disease (two), sickle cell disease (one), epilepsy (three), cerebral palsy (six), myotonic dystrophy (four) and peroxisomal biogenesis defect (one).

Six children (33%) presented with abdominal distension, four (22%) with abdominal pain, three (17%) with bilious vomiting, two (11%) with diarrhoea and one (6%) with rectal bleeding. Two (11%) were asymptomatic. One had air in portal vein and two had pneumoperitoneum.

All patients with symptomatic PI were treated conservatively with successful outcome and complete resolution of PI. None required surgical intervention.

Conclusion 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.

  • gastroenterology
  • paediatric surgery
  • general paediatrics

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Footnotes

  • Contributors LN: collected the data and jointly wrote the manuscript. MM: jointly wrote the manuscript. DT: collected and analysed the data and wrote the manuscript. JK: supervised data collection, revised and edited the manuscript. MU: supervised the project, identified patients and revised and edited the manuscript.

  • Competing interests None declared.

  • Ethics approval Institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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