Advertisement

Pediatric Radiology

, Volume 38, Issue 10, pp 1074–1083 | Cite as

Clinical and CT features of benign pneumatosis intestinalis in pediatric hematopoietic stem cell transplant and oncology patients

  • M. Beth McCarvilleEmail author
  • Sarah B. Whittle
  • Geoffrey S. Goodin
  • Chin-Shang Li
  • Matthew P. Smeltzer
  • Gregory A. Hale
  • Robert A. Kaufman
Original Article

Abstract

Background

Pneumatosis intestinalis in children is associated with a wide variety of underlying conditions and often has a benign course. The CT features of this condition have not been systematically investigated.

Objective

Defining benign pneumatosis intestinalis as pneumatosis intestinalis that resolved with medical management alone, we sought to: (1) determine whether the incidence of benign pneumatosis intestinalis had increased at our pediatric cancer hospital; (2) characterize CT features of benign pneumatosis intestinalis; and (3) determine the relationship between imaging features and clinical course of benign pneumatosis intestinalis in this cohort.

Materials and methods

Radiology reports from November 1994 to December 2006 were searched for “pneumatosis intestinalis,” “free intraperitoneal air,” and “portal venous air or gas.” Corresponding imaging was reviewed by two radiologists who confirmed pneumatosis intestinalis and recorded the presence of extraluminal free air, degree of intramural gaseous distension, number of involved bowel segments, and time to pneumatosis resolution.

Results

The search revealed 12 boys and 4 girls with pneumatosis intestinalis; 11 were hematopoietic stem cell transplant recipients. The annual incidences of benign pneumatosis have not changed at our institution. Increases in intramural distension marginally correlated with the number of bowel segments involved (P=0.08). Three patients had free air and longer times to resolution of pneumatosis (P=0.03).

Conclusion

Male children may be at increased risk of benign pneumatosis intestinalis. The incidence of benign pneumatosis at our institution is proportional to the number of hematopoietic stem cell transplants. The degree of intramural distension may correlate with the number of bowel segments involved. Patients with free air have a longer time to resolution of benign pneumatosis.

Keywords

Pneumatosis intestinalis Children Cancer Hematopoietic stem cell transplant 

Notes

Acknowledgement

This study was supported in part by The Pediatric Oncology Education Program grant 5R25 CA23944 from the National Cancer Institute and The American, Lebanese and Syrian Associated Charities.

References

  1. 1.
    Fenton LZ, Buonomo C (2000) Benign pneumatosis in children. Pediatr Radiol 30:786–793PubMedCrossRefGoogle Scholar
  2. 2.
    Knechtle SJ, Davidoff AM, Rice RP (1990) Pneumatosis intestinalis. Surgical management and clinical outcome. Ann Surg 212:160–165PubMedCrossRefGoogle Scholar
  3. 3.
    West KW, Rescorla FJ, Grosfeld JL et al (1989) Pneumatosis intestinalis in children beyond the neonatal period. J Pediatr Surg 24:818–822PubMedCrossRefGoogle Scholar
  4. 4.
    Keats TE, Smith TH (1974) Benign pneumatosis intestinalis in childhood leukemia. Am J Roentgenol Radium Ther Nucl Med 122:150–152PubMedGoogle Scholar
  5. 5.
    Sivit CJ, Josephs SH, Taylor GA et al (1990) Pneumatosis intestinalis in children with AIDS. AJR 155:133–134PubMedGoogle Scholar
  6. 6.
    Yeager AM, Kanof ME, Kramer SS et al (1987) Pneumatosis intestinalis in children after allogeneic bone marrow transplantation. Pediatr Radiol 17:18–22PubMedCrossRefGoogle Scholar
  7. 7.
    Hernanz-Schulman M, Kirkpatrick J, Shwachman H et al (1986) Pneumatosis intestinalis in cystic fibrosis. Radiology 160:497–499PubMedGoogle Scholar
  8. 8.
    Burton EM, Mercado-Deane MG, Patel K (1994) Pneumatosis intestinalis in a child with AIDS and pseudomembranous colitis. Pediatr Radiol 24:609–610PubMedCrossRefGoogle Scholar
  9. 9.
    Kurbegov AC, Sondheimer JM (2001) Pneumatosis intestinalis in non-neonatal pediatric patients. Pediatrics 108:402–406PubMedCrossRefGoogle Scholar
  10. 10.
    Ho LM, Paulson EK, Thompson WM (2007) Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR 188:1604–1613PubMedCrossRefGoogle Scholar
  11. 11.
    Byrd BF, Sawyers JL, Bomar RL et al (1968) Reversible vascular occlusion of the colon: recognition and management. Ann Surg 167:901–907PubMedCrossRefGoogle Scholar
  12. 12.
    Stiennon OA (1951) Pneumatosis intestinalis in the newborn. Am J Dis Child 81:651–663Google Scholar
  13. 13.
    Keyting WS, McCarver RR, Kovarik JL et al (1961) Pneumatosis intestinalis: a new concept. Radiology 76:733–741PubMedGoogle Scholar
  14. 14.
    Kleinman PK, Brill PW, Winchester P (1980) Pneumatosis intestinalis. Its occurrence in the immunologically compromised child. Am J Dis Child 134:1149–1151PubMedGoogle Scholar
  15. 15.
    Borns PF, Johnston TA (1973) Indolent pneumatosis of the bowel wall associated with immune suppressive therapy. Ann Radiol 16:163–166Google Scholar
  16. 16.
    Pear BL (1998) Pneumatosis intestinalis: a review. Radiology 207:13–19PubMedGoogle Scholar
  17. 17.
    Maile CW, Frick MP, Crass JR et al (1985) The plain abdominal radiograph in acute gastrointestinal graft-vs.-host disease. AJR 145:289–292PubMedGoogle Scholar
  18. 18.
    Feczko PJ (1992) Clinical significance of pneumatosis of the bowel wall. Radiographics 12:1069–1078PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • M. Beth McCarville
    • 1
    • 2
    Email author
  • Sarah B. Whittle
    • 1
  • Geoffrey S. Goodin
    • 1
    • 2
  • Chin-Shang Li
    • 3
  • Matthew P. Smeltzer
    • 3
  • Gregory A. Hale
    • 4
    • 5
  • Robert A. Kaufman
    • 1
    • 2
    • 5
  1. 1.Department of Radiological SciencesSt. Jude Children’s Research HospitalMemphisUSA
  2. 2.Department of RadiologyThe University of Tennessee College of MedicineMemphisUSA
  3. 3.Department of BiostatisticsSt. Jude Children’s Research HospitalMemphisUSA
  4. 4.Department of OncologySt. Jude Children’s Research HospitalMemphisUSA
  5. 5.Department of PediatricsThe University of Tennessee College of MedicineMemphisUSA

Personalised recommendations