Pneumatosis intestinalis in children beyond the neonatal period: is it always benign?

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.