Pneumatosis intestinalis in the pediatric oncology population: An 11‐year retrospective review at Memorial Sloan Kettering Cancer Center

Abstract

Background: Pneumatosis intestinalis (PI) is characterized by the presence of intramural gas in the gastrointestinal (GI) tract. The overall aim of this study was to review risk factors and outcome of pediatric oncology patients at our institution who developed PI. Procedure: Patients diagnosed with PI between 2007 and 2018 were identified from ICD-10 coding of radiology reports at Memorial Sloan Kettering Kids, a tertiary pediatric oncology center. Outcomes of interest were (a) resolution and time to resolution of PI, (b) surgical intervention within 2 weeks of diagnosis of PI, or (c) death secondary to PI. To capture the resolution of PI, we defined the "time to recovery (TTR)" as the time elapsed between date of PI diagnosis and the date of recovery.Results: Forty-two patients were identified. Within 30 days of diagnosis of PI, three patients had surgical intervention for PI (7%) and two patients died (5%) due to non-PI causes. Median TTR of PI was 4.5 days (95% CI: 3-7 days). In univariable and multivariable analyses, only steroid use in the prior 30 days was significantly associated with a faster TTR of PI (HR = 2.27 [95% CI: 1.17-4.41], p = .02).Conclusions: This is the largest case series of patients with PI in the pediatric oncology population, which reveals significantly lower surgical and mortality rates than other published PI series. For the majority of patients, conservative medical management is indicated. A prospective study is warranted to define diagnosis and management guidelines for PI in the pediatric oncology population in a cooperative group setting.

Pneumatosis cystoides intestinalis with fatal air embolism after minor blunt abdominal trauma in a 6-year-old girl undergoing hematopoietic stem cell trasplant: case report and review of literature

“… 2 The estimated incidence of PCI in the pediatric oncology population is 1%. 4 The use of chemotherapeutic agents (i.e., cyclophosphamide, cytarabine, vincristine, doxorubicin, daunorubicin, etoposide, docetaxel, irinotecan, and cisplatin), immunosuppressive drugs (i.e., corticosteroids), infectious colitis, septic shock, and GVHD emerge as important causes of PCI in the pediatric population in the non-neonatal period. 3 , 5 Several pathophysiological mechanisms leading to PCI have been described.…”

“…The development of asymptomatic PCI is a benign condition following HCT. 4 The risk of PCI is increased in patients with gastrointestinal GVHD, in patients receiving steroid therapy, and in those relying on supplemental nasogastric tube feeds for at least one-half of their total daily nutrition. 6 Cases of PCI in patients with cGVHD described in the literature occurred 2–8 months after bone marrow transplantation and were usually mild.…”

Complications of Cancer Therapy in Children: A Comprehensive Review of Body Imaging Findings

“…39 Patients may present with abdominal pain, although pneumatosis may occur as an incidental finding in asymptomatic patients. 45,46 Pneumatosis may be associated with potentially severe bowel pathologies such as infection or ischemia, but often has a benign course in pediatric oncology patients. 46 Pneumatosis is frequently discovered on abdominal radiographs but may also be seen on CT or even US (Fig.…”

“…Occasionally, free intraperitoneal air or portal venous gas is seen. 45,46 Treatment consists of bowel rest and antimicrobial therapy.…”

“…Pneumatosis intestinalis occurs in approximately 1% of pediatric cancer patients 39 . Patients may present with abdominal pain, although pneumatosis may occur as an incidental finding in asymptomatic patients 45,46 . Pneumatosis may be associated with potentially severe bowel pathologies such as infection or ischemia, but often has a benign course in pediatric oncology patients 46 .…”