Abstract
Four children, ages 3 to 8 years, developed pneumatosis intestinalis (PI) after allogeneic bone marrow transplantation (BMT) for acute leukemia or severe aplastic anemia. PI was detected at a median of 48 days (range, 10–63 days) after BMT and was associated with abdominal symptoms and clinical signs. All patients had severe systemic and/or high-grade cutaneous acute graft-versus-host disease (AGVHD) at some time after BMT and were receiving corticosteroids at the time of development of PI; however, PI was associated with concomitant severe AGVHD in only one patient. One patient with PI hadHafnia alvei bacteremia and another patient had gastroenteritis due to rotavirus and adenovirus. All patients were treated with supportive care and systemic broad-spectrum antibiotics, and PI resolved 2–16 days after onset. Two patients died with BMT-associated complications unrelated to PI. Multiple factors contribute to the development of PI after BMT, and the prognosis for recovery from PI is good with medical management alone. Overall survival in these patients is dependent on the frequency and severity of other conditions, such as AGVHD and opportunistic infections, after BMT.
Similar content being viewed by others
References
Ecker JA, Williams RG, Clay KL (1971) Pneumatosis cystoides intestinalis — bullous emphysema of the intestine. Am J Gastroenterol 56: 125
Marshak RH, Lindner AE, Milano AM (1971) Pneumatosis coli. Am J Gastroenterol 56: 68
Vichi GF, Maggini M, Moggi P, Gori F, Paoli F (1973) Pneumatosis intestinalis in infants: clinical, radiological, and anatomopathological study on eighteen patients. Ann Radiol 16: 153
Wood RE, Herman CJ, Johnson KW, di Sant'Agnese PA (1975) Pneumatosis coli in cystic fibrosis. Am J Dis Child 129: 246
Mueller C, Morehead R, Alter A, Michener W (1972) Pneumatosis intestinalis in collagen disorders. Am J Roentgenol 115: 300
Oliveros M, Herbst J, Lester P, Ziter F (1973) Pneumatosis intestinalis and childhood dermatomyositis. Pediatrics 52: 711
Braunstein EM, White SJ (1980) Pneumatosis intestinalis in dermatomyositis. Br J Radiol 53: 1011
Jaffe N, Carlson DH, Vawter GF (1972) Pneumatosis cystoides intestinalis in acute leukemia. Cancer 30: 239
Borns PF, Johnston TA (1973) Indolent pneumatosis of the bowel wall associated with immune suppressive therapy. Ann Radiol 16: 163
Keats TE, Smith TH (1974) Benign pneumatosis intestinalis in childhood leukemia. Am J Roentgenol Radium Ther Nucl Med 122: 150
Galal O, Osse G, Weigel W, Gahr M (1981) Pneumatosis intestinalis in children with leukaemia: report of three cases. Eur J Pediatr 137: 91
Miholic J, Kummer M (1983) Pneumatosis intestinalis in childhood leukaemia: report of a case with gas in the portal vein and review of the literature. Helv Paediatr Acta 38: 533
Braver JM, Horrow MM, Philipps E (1984) Leukemic intestinal pneumatosis. J Can Assoc Radiol 35: 80
Kleinman PK, Brill PW, Winchester P (1980) Pneumatosis intestinalis: its occurrence in the immunologically compromised child. Am J Dis Child 134: 1149
Wall LL, Linshaw MA, Bailie MD, Pierce GE (1982) Pneumatosis intestinalis in a pediatric renal transplant patient. J Pediatr 101: 745
Navari RM, Sharma P, Deeg HJ, McDonald GB, Thomas ED (1983) Pneumatosis cystoides intestinalis following allogeneic marrow transplantation. Transplant Proc 15: 1720
Santos GW, Tutschka PJ, Brookmeyer R, et al. (1983) Marrow transplantation for acute nonlymphocytic leukemia after treatment with busulfan and cyclophosphamide. N Engl J Med 309: 1347
Glucksberg H, Storb R, Fefer A, et al. (1974) Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 18: 295
Slavin RE, Santos GW (1973) The graft-versus-host reaction in man after bone marrow transplantation: pathology, pathogenesis, clinical features, and implication. Clin Immunol Immunopathol 1: 472
Santos GW, Bias WB, Beschorner WE, et al. (1983) Allogeneic and syngeneic marrow transplantation for acute lymphocytic leukemia (ALL) in remission — Baltimore experience. Exp Hematol 11 (Suppl 14): 132 [Abstract]
Speck B, Gluckman E, Haak HL, Van Rood JJ (1977) Treatment of aplastic anaemia by antilymphocyte globulin with and without allogeneic bone-marrow infusions. Lancet 2: 1145
McCarthy D, Holland I, Lavender JP, Catovsky D (1979) Pneumatosis coli in adult acute myeloid leukaemia. Clin Radiol 30: 175
O'Connell DJ, Thompson AJ (1978) Pneumatosis coli in non-Hodgkin's lymphoma. Br J Radiol 51: 203
Shindelman LE, Geller SA, Wisch N, Bauer JJ (1981) Pneumatosis cystoides intestinalis: a complication of systemic chemotherapy. am J Gastroenterol 75: 270
Kleinman P, Meyers MA, Abbott G, Kazam E (1976) Necrotizing enterocolitis with pneumatosis intestinalis in systemic lupus erythematosus and polyarteritis. Radiology 121: 595
Derksen OS (1978) Pneumatosis intestinalis in a female patient with systemic lupus erythematosus. Radiol Clin 47: 334
Koep LJ, Peters TG, Starzl TE (1979) Major colonic complications of hepatic transplantation. Dis Col Rect 22: 218
Smith BH, Welter LH (1967) Pneumatosis intestinalis. Am J Clin Path 48: 455
Gupta A (1978) Pneumatosis intestinalis in children. Br J Radiol 51: 589
Townsend TR, Bolyard EA, Yolken RH, et al. (1982) Outbreak of Coxsackie A1 gastroenteritis: a complication of bone-marrow transplantation. Lancet I: 820
Yolken RH, Bishop CA, Townsend TR, et al. (1982) Infectious gastroenteritis in bone-marrow transplant recipients. N Engl J Med 306: 1009
Lubitz L, Ekert H (1979) Reversible changes in duodenal mucosa associated with intensive chemotherapy followed by autologous marrow rescue. Lancet 2: 532
Epstein RJ, McDonald GB, Sale GE, Shulman HM, Thomas ED (1980) The diagnostic accuracy of the rectal biopsy in acute graft-versus-host disease: a prospective study of thirteen patients. Gastroenterology 78: 764
Slavin RE, Dias MA, Saral R (1978) Cytosine-arabinoside induced gastrointestinal toxic alterations in sequential chemotherapeutic protocols: a clinical-pathological study of 33 patients. Cancer 42: 1747
Forgacs P, Wright PH, Wyatt AP (1973) Treatment of intestinal gas cyst by oxygen breathing. Lancet 1: 579
Connor R, Jones B, Fishman EK, Siegelman SS (1984) Pneumatosis intestinalis: role of computed tomography in diagnosis and management. J Comput Assist Tomogr 8: 269
Kelvin FM, Korobkin M, Rauch RF, Rice RP, Silverman PM (1984) Computed tomography of pneumatosis intestinalis. J Comput Assist Tomogr 8: 276
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Yeager, A.M., Kanof, M.E., Kramer, S.S. et al. Pneumatosis intestinalis in children after allogeneic bone marrow transplantation. Pediatr Radiol 17, 18–22 (1987). https://doi.org/10.1007/BF02386589
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02386589