title: [Conservative treatment of pneumatosis intestinalis and pneumoperitoneum after bone marrow transplantation].
abstract: OBJECTIVE
  Pneumatosis intestinalis (PI) is a radiological sign that can be accompanied by pneumoperitoneum. It is not exclusive of neonatal necrotizing enterocolitis. It can also appear after bone marrow transplantation. We describe our experience with 6 patients diagnosed of PI after bone marrow transplantation (BMT) who were treated conservatively without surgery in any case and good outcome.
  
  
  METHODS
  We have reviewed the patients diagnosed of PI from 2000 to 2007 after BMT in our center.
  
  
  RESULTS
  Six patients have had 7 episodes of PI with pneumoperitoneum in 3. All cases previously developed intestinal graft-versus-host disease. PI was diagnosed from 1 to 4 months after transplantation. At diagnosis, any patient presented peritoneal signs. Computed tomography was used for PI diagnosis with colonic predominance (5), pneumomediastinum (1) and retropneumoperitoneum (2). The treatment was conservative with intestinal rest, antibiotics and total parenteral nutrition. Enteral feeding was initiated progressively between 1 and 2 months after diagnosis but in one case PI reappeared and it required to start again the conservative treatment. In the other cases, outcome was very satisfactory, improving the pneumatosis and with a correct oral feeding without needing of surgery in any case.
  
  
  CONCLUSIONS
  PI with or without pneumoperitoneum is an condition to have in mind in bone marrow transplantation patients. Pneumoperitoneum with good general condition and no sign of peritonitis is not indicative of surgery in these patients. Conservative treatment with antibiotics and parenteral nutrition allows resolution spontaneously
authors.affiliation: Departamento de Cirugía Pediátrica, Hospital Infantil Vall d'Hebrón, Barcelona. conxbarcelo@yahoo.es
authors.forename: C Barceló
authors.initials: CB
authors.lastname: Cañellas
authors.forename: C Marhuenda
authors.initials: CM
authors.lastname: Irastorza
authors.forename: T
authors.initials: T
authors.lastname: Olivé
authors.forename: A Moreno
authors.initials: AM
authors.lastname: Montero
authors.forename: G Guillén
authors.initials: GG
authors.lastname: Burrieza
authors.forename: J A Molino
authors.initials: JA
authors.lastname: Gaethe
authors.forename: J Lloret
authors.initials: JL
authors.lastname: Rocal
authors.forename: V
authors.initials: V
authors.lastname: Martínez-Ibáñez
mesh_terms: D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011006:Pneumatosis Cystoides Intestinalis / Q000209:etiology* / Q000628:therapy*; D011027:Pneumoperitoneum / Q000209:etiology* / Q000628:therapy*