Clinical Predictors and Outcomes for Recurrent Pneumatosis Intestinalis in Children: A Case Control Study

Abstract

Introduction: Pneumatosis intestinalis (PI) is air collections within the wall of the intestine that can be associated with life threatening conditions. Recurrent episodes of PI have been reported; however, little is known about risks for recurrent disease. This study aims to identify predictors of recurrent PI and evaluate long-term outcomes in patients with recurrent PI. Methods: This retrospective case-control study evaluated patients, ages 6 months to 18 years, with imaging evidence of PI over a 30-month period. Images were analyzed by consensus to confirm PI. Recurrent PI was defined as new findings of PI after resolution by imaging and/or at least 1-month interval between episodes of PI. Univariate and multivariable analyses were performed using logistic regression, with significance set to P < 0.05. Results: Forty-six children were included. Recurrent PI occurred in 17 (37%) patients, with a total of 39 episodes. Predictors of recurrent PI all related to the segment of bowel involved with small bowel PI predictive of recurrent PI (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.01, 2.4) and colonic PI protective (OR 0.6; 95% CI 0.4, 0.87) after adjusting for age. Predictors for surgical intervention included cerebral palsy (OR 17; 95% CI 1.7, 167) and PI involving small bowel (OR 19; 95% 3.1, 114). Conclusion: Location of PI is predictive of recurrence. Clinical outcomes were similar between groups with single episode and recurrent PI.

Pneumatosis Intestinalis in Children With Intestinal Failure: The Result of Intestinal Stress From Enteral Feeding?

“…Prior studies focusing on recurrent PI have identiied an anatomical association in that PI located in the small bowel is more likely to recur than PI located in the large bowel, however, the reasons for this is unclear (15). An interesting inding of this study was the association between type of nutritional support and the development of PI.…”

“…However, this series is too small to offer to support to this theory and more data are needed. Prior studies focusing on recurrent PI have identified an anatomical association in that PI located in the small bowel is more likely to recur than PI located in the large bowel, however, the reasons for this is unclear (15).…”

“…Notably, however, no patients in their series had intestinal failure. Conservative management for PI has been described previously (1–3,15). Though presence of PI can be concerning for clinicians, no patients in our cohort died during an episode of PI.…”

“…There were 85 (77.3%) patients in intestinal continuity and 63 (57.3%) who underwent prior bowel resection. The location of patients' stomas was ileal (15), jejunal (4), and colonic (6). Remnant small bowel length (cm) was available for 33 patients.…”