Pneumatosis intestinalis (PI) is a well-recognized manifestation of necrotizing enterocolitis (NEC) in the new-born-a condition that oftern requires surgical intervention for infarcted bowel. However, little information is available concerning PI in older children or its management. Sixteen older infants and children (>2 months) had x-ray findings of PI (intramural air). There were eight girls and eight boys ranging in age from 2 months to 8 years. Associated conditions included short bowel syndrome (SBS) (8), congenital heart disease (2), iron ingestion (1), nesidioblastosis (1), hemolytic anemia (1), rheumatoid arthritis (1), bronchopulmonary dysplasia (BPD) (1), and malrotation (1). Clinical presentation included abdominal distension (13), bloody diarrhea (12), bilious emesis (5), and lethargy (5). Two patients on steroids had unsuspected PI identified as an incidental operative finding during pancreatectomy for nesidioblastosis (1) and splenectomy for hemolytic anemia (1), respectively. Only four other children (iron toxicity, postcardiac catheterization, rheumatoid arthritis, and BPD required surgical intervention. Each manifested peritioneal irritation, acidosis, and hypotension or had pneumoperitoneum on abdominal x-ray. In ten of 14 patients, PI was managed nonoperatively with neasogastric suction, fluid resuscitation, intravenous (IV) antibiotics (seven to ten days), and repeated abdominal x-ray and physical examinations. Children with SBS comprised 50% of the total number of patients and eight of ten treated by observation. All had associated viral syndromes (rotavirus) or rhotozyme-positive stools and developed bloody diarrhea. There were two deaths (12.5%) in patients with iron toxicity and congenital heart disease who required resection of gangrenous bowel. All of the other patients survived. These observations suggest that in older infants and children, careful nonoperative management and antibiotic therapy can be safely employed in instances of pneumatosis intestinalis. In 75% of these children (including all with SBS), PI was successfully managed nonoperatively. In older children, pneumatosis intestinalis alone is not an indication for operation. Operation is indicated, however, in patients with pneumoperitoneum and/or signs of progressive clinical deterioration (acidosis, peritoneal irritation, etc) as is currently practiced in the management of the neonatal PI group. The relationship of steroid administration and pneumatosis intestinalis is unclear. Rotavirus infection frequently occurs in infants and children with SBS and might be implicated in the development of their pneumatosis intestinalis. None of the patients with SBS required operative intervention. Intestinal adaptation, however, was significantly delayed in these cases. PI has not been previously reported as a late complication of SBS. Loss of mucosal integrity and subsequent bacterial invasion might be etiologic factors in these cases.
- Pneumatosis intestinalis
- short bowel syndrome
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health