Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

The significance and management of pediatric pneumatosis intestinalis (PI) remains poorly defined. We sought to add clarity in children beyond the neonatal period.

Methods

Pediatric patients 3 months–18 years admitted to a quaternary children’s hospital with a diagnosis of PI were included in this retrospective study. Pathologic PI was defined as irreversible, transmural intestinal ischemia.

Results

167 children were identified with PI. Of these children, 155 (92.8%) had benign PI and 12 (7.2%) developed pathologic PI. The most common underlying diagnosis for pathologic PI was global developmental delay (75%), although we identified a spectrum of underlying diagnoses at risk for PI. Physical exam notable for abdominal distension (p = 0.023) or guarding (p = 0.028), and imaging with portal venous gas (p < 0.001) or bowel distension (p = 0.001) were significantly associated with pathologic PI. Only 6.6% of all children underwent an operation. For those undergoing non-surgical management of benign PI, 75% of children received antibiotics and average duration of bowel rest was 6.8 days.

Conclusions

PI in children is primarily a benign phenomenon and often does not warrant surgical intervention. Bowel rest and antibiotics are therapeutic strategies frequently used in the treatment of this finding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Torres US, Fortes C, Ps S, Di Tiferes Da G (2018) Pneumatosis from esophagus to rectum: a comprehensive review focusing on clinico-radiological differentiation between benign and life-threatening causes. Semin Ultrasound Ct Mr 39(2):167–182. https://doi.org/10.1053/J.Sult.2017.09.002

    Article  PubMed  Google Scholar 

  2. Gupta A (1978) Pneumatosis intestinalis in children. Br J Radiol 51(608):589–595. https://doi.org/10.1259/0007-1285-51-608-589

    Article  CAS  PubMed  Google Scholar 

  3. Heng Y, Schuffler Md, Rc H, Ca R (1995) Pneumatosis intestinalis: a review. Am J Gastroenterol 90(10):1747–1758

    CAS  PubMed  Google Scholar 

  4. Aj G, Sq N, Berlin A, Corona J, Lee J, Wong E et al (2007) Pneumatosis intestinalis in adults: management, surgical indications, and risk factors for mortality. J Gastrointest Surg 11(10):1268–1274. https://doi.org/10.1007/S11605-007-0241-9

    Article  Google Scholar 

  5. Bl P (1998) Pneumatosis intestinalis: a review. Radiology 207(1):13–19. https://doi.org/10.1148/Radiology.207.1.9530294

    Article  Google Scholar 

  6. St Peter SD, Abbas MA, Kelly KA (2003) The spectrum of pneumatosis intestinalis. Arch Surg (Chicago, III: 1960). 138(1):68–75. https://doi.org/10.1001/Archsurg.138.1.68

    Article  Google Scholar 

  7. Gagliardi G, Iw T, Mj H, Forbes A, Pr H, Ic T (1996) Pneumatosis Coli: a proposed pathogenesis based on study of 25 cases and review of the literature. Int J Colorectal Dis 11(3):111–118. https://doi.org/10.1007/S003840050031

    Article  CAS  PubMed  Google Scholar 

  8. Galandiuk S, Fazio VW (1986) Pneumatosis cystoides intestinalis. A review of the literature. Dis Colon Rectum 29(5):358–363

    Article  CAS  Google Scholar 

  9. Eaton S, Cm R, Nj H (2017) Current research on the epidemiology, pathogenesis and management of necrotizing enterocolitis. Neonatology 111(4):423–430. https://doi.org/10.1159/000458462

    Article  PubMed  Google Scholar 

  10. Pourcyrous M, Sb K, Yang W, Tf B, Hs B (2005) C-reactive protein in the diagnosis, management, and prognosis of neonatal necrotizing enterocolitis. Pediatrics 116(5):1064–1069. https://doi.org/10.1542/Peds.2004-1806

    Article  PubMed  Google Scholar 

  11. Neu J, Wa W (2011) Necrotizing enterocolitis. N Engl J Med 364(3):255–264. https://doi.org/10.1056/Nejmra1005408

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Sylvester KG, Liu GY, Albanese CT (2012) Necrotizing enterocolitis. Ped Surg. https://doi.org/10.1016/B978-0-323-07255-7.00094-5

    Article  Google Scholar 

  13. Wiesner W, Kj M, Jn G, Ji H, Pr R (2001) Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of ct findings with severity of ischemia and clinical outcome. Am J Roentgenol 177(6):1319–1323. https://doi.org/10.2214/Ajr.177.6.1771319

    Article  CAS  Google Scholar 

  14. Pn K, Huber-Wagner S, Ladurner R, Kleespies A, Siebeck M, Mutschler W et al (2009) Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis. Eur J Med Res 14(6):231–239. https://doi.org/10.1186/2047-783x-14-6-231

    Article  Google Scholar 

  15. Knechtle SJ, Davidoff AM, Rice RP (1990) Pneumatosis intestinalis. Surgical management and clinical outcome. Ann Surg 212(2):160–165. https://doi.org/10.1097/00000658-199008000-00008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Goyal R, Hk L, Akerman M, Lw M (2017) Clinical and imaging features indicative of clinically worrisome pneumatosis: key components to identifying proper medical intervention. Emerg Radiol 24(4):341–346. https://doi.org/10.1007/S10140-017-1484-8

    Article  PubMed  Google Scholar 

  17. De O, Yw K, Ying J, Lf D (2009) Ct Predictors for differentiating benign and clinically worrisome pneumatosis intestinalis in children beyond the neonatal period. Radiology 253(2):513–519. https://doi.org/10.1148/Radiol.2532090168

    Article  Google Scholar 

  18. Ks L, Hwang S, Sm HR, Yy J, Mj G (2013) Distinguishing benign and life-threatening pneumatosis intestinalis in patients with cancer by CT imaging features. Am J Roentgenol 200(5):1042–1047. https://doi.org/10.2214/Ajr.12.8942

    Article  Google Scholar 

  19. Lm Ho, Ek P, Wm T (2007) Pneumatosis intestinalis in the adult: benign to life-threatening causes. Am J Roentgenol 188(6):1604–1613. https://doi.org/10.2214/Ajr.06.1309

    Article  Google Scholar 

  20. Cj R, Er D, Rm H, Kj C, Ct K, Jb M et al (2021) Development and validation of a five-factor score for prediction of pathologic pneumatosis. J Trauma Acute Care Surg 90(3):477–483. https://doi.org/10.1097/Ta.0000000000002989

    Article  Google Scholar 

  21. Ferrada P, Callcut R, Bauza G, O’bosky KR, Luo-Owen X, Mansfield NJ et al (2017) Pneumatosis intestinalis predictive evaluation study: a multicenter epidemiologic study of The American Association For The Surgery Of Trauma. J Trauma Acute Care Surg 82(3):451–460. https://doi.org/10.1097/Ta.0000000000001360

    Article  PubMed  Google Scholar 

  22. Wallace G, Rosen N, Aj T, Jodele S, Kc M, Sm D et al (2021) Pneumatosis intestinalis after hematopoietic stem cell transplantation: when not doing anything is good enough. J Pediatr Surg. https://doi.org/10.1016/J.Jpedsurg.2020.12.020

    Article  PubMed  Google Scholar 

  23. Jj D, Lissauer M, Aa M, Gl P, Ta O, Luo-Owen X et al (2013) Pneumatosis intestinalis predictive evaluation study (Pipes): a multicenter epidemiologic study of the eastern association for the surgery of trauma. J Trauma Acute Care Surg 75(1):15–23. https://doi.org/10.1097/Ta.0b013e318298486e

    Article  Google Scholar 

  24. Cr H, Sm H, Jaksic T (2018) Surgical considerations for neonates with necrotizing enterocolitis. Semin Fetal Neonatal Med 23(6):420–425. https://doi.org/10.1016/J.Siny.2018.08.007

    Article  Google Scholar 

  25. Aj M, Ma V, Brownie E, La D, Kb N, Klein Md (2015) Timing of optimal surgical intervention for neonates with necrotizing enterocolitis. Am Surg 81(5):438–443

    Article  Google Scholar 

  26. Nellihela L, Mutalib M, Thompson D, Jochen K, Upadhyaya M (2018) Management of pneumatosis intestinalis in children over the age of 6 months: a conservative approach. Arch Dis Child 103(4):352–355. https://doi.org/10.1136/Archdischild-2017-313201

    Article  PubMed  Google Scholar 

  27. Galea J, Km B, Fl D, Ck S, Rex D, Bo O (2017) Pneumoperitoneum in the setting of pneumatosis intestinalis in children: is surgery always indicated? Eur J Pediatr Surg 27(1):12–15. https://doi.org/10.1055/S-0036-1587335

    Article  PubMed  Google Scholar 

  28. Ac K, Jm S (2001) Pneumatosis intestinalis in non-neonatal pediatric patients. Pediatrics 108(2):402–406. https://doi.org/10.1542/Peds.108.2.402

    Article  Google Scholar 

Download references

Funding

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Author information

Author notes

  1. Alexey Abramov and Valerie L. Luks have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA

    Alexey Abramov

  2. Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Valerie L. Luks

  3. Division of Pediatric General, Thoracic and Fetal Surgery, Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Felix De Bie, Rosa Hwang, Myron Allukian III & Gary W. Nace Jr.

Authors
  1. Alexey Abramov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valerie L. Luks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Felix De Bie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rosa Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Myron Allukian III
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gary W. Nace Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by AA, VL, FDB, and RH. Analysis was performed by AA, MA, and GWN. The first draft of the manuscript was written by AA and VL and all the authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gary W. Nace Jr..

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes. The IRB of Children’s Hospital of Philadelphia granted ethical approval for this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abramov, A., Luks, V.L., De Bie, F. et al. Pneumatosis intestinalis in children beyond the neonatal period: is it always benign?. Pediatr Surg Int 38, 399–407 (2022). https://doi.org/10.1007/s00383-021-05048-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-021-05048-0

Keywords

Search

Navigation