Pneumatosis intestinalis in a cohort of children with neurological impairment: A patient group with a management dilemma

Abstract

In neurologically impaired school-age children, the presence of pneumatosis and pneumoperitoneum does not mandate bowel ischaemia or perforation and therefore could be successfully managed conservatively without the need for surgery.

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

“…Management of PI can often be conservative consisting of NPO and antibiotic treatment (10,12), however there are no consensus guidelines for management. In our study, resolution of PI was used clinically in many patients as criteria to advance enteral feedings and discontinue antibiotics.…”

“…In the setting of pneumatosis, the extent of mesenteric ischemia has been associated with poor outcomes including surgery and death in addition to pneumoperitoneum and/or portal venous gas (3,5,10,21,25,26); however, both pediatric and adult cases of pneumoperitoneum have been managed conservatively when patients are clinically stable suggesting some finding may represent ruptured cystic structures rather than transmural bowel wall perforation (12,(27)(28)(29)(30). In this study, conservative management was pursued in >50% of cases in the setting of pneumoperitoneum (11/ 16 episodes) and portal venous gas (3/6 episodes).…”

“…Previous literature has described recurrent PI in small case series’ of pediatric patients with cerebral palsy (12) or hematopoietic stem cell transplant (13); however, further details of their clinical course and drivers of recurrence was not evaluated. In this case–control study, we show that 37% of children greater than 6 months of age had recurrent PI and the location of PI at the first episode is predictive of recurrent PI.…”

“…In pediatrics, PI is most commonly seen in the neonatal period secondary to necrotizing enterocolitis (10) and is less frequently observed in older children (11). Recurrent episodes of PI have been reported in case series at a frequency of 15-80% (10,12,13). To our knowledge, there are no studies specifically evaluating predictors of recurrent PI or defining recurrent episodes of PI.…”

A 9‐year‐old boy with severe motor and intellectual disabilities and prolonged abdominal distension

“…Pneumatosis intestinalis is uncommon after the neonatal period. Associated factors include infection, post‐transplantation, cow's milk allergy, gastrointestinal problems, and medication, whereas children with neurologic impairment or tube feeding have also been reported 3–6 . Flatulence is known as an adverse effect of alpha‐glucosidase inhibitors, which are effective for dumping syndrome; this may lead to pneumatosis intestinalis 7–9 .…”