Pneumatosis intestinalis in children beyond the neonatal period: is it always benign?
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In brief
In brief
Retrospective study of 167 pediatric patients shows pneumatosis intestinalis is benign in 93% of cases beyond the neonatal period, with only 7% developing pathologic transmural ischemia. Physical exam findings of distension or guarding, plus imaging showing portal venous gas or bowel distension, predict pathologic disease requiring surgery.
Written by the GCMD Library team from the article.
Abstract
Purpose
The significance and management of pediatric pneumatosis intestinalis (PI) remains poorly defined. We sought to add clarity in children beyond the neonatal period.
Methods
Pediatric patients 3 months–18 years admitted to a quaternary children’s hospital with a diagnosis of PI were included in this retrospective study. Pathologic PI was defined as irreversible, transmural intestinal ischemia.
Results
167 children were identified with PI. Of these children, 155 (92.8%) had benign PI and 12 (7.2%) developed pathologic PI. The most common underlying diagnosis for pathologic PI was global developmental delay (75%), although we identified a spectrum of underlying diagnoses at risk for PI. Physical exam notable for abdominal distension (p = 0.023) or guarding (p = 0.028), and imaging with portal venous gas (p < 0.001) or bowel distension (p = 0.001) were significantly associated with pathologic PI. Only 6.6% of all children underwent an operation. For those undergoing non-surgical management of benign PI, 75% of children received antibiotics and average duration of bowel rest was 6.8 days.
Conclusions
PI in children is primarily a benign phenomenon and often does not warrant surgical intervention. Bowel rest and antibiotics are therapeutic strategies frequently used in the treatment of this finding.