[Conservative treatment of pneumatosis intestinalis and pneumoperitoneum after bone marrow transplantation].
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
Cañellas
C Barceló
CB
Departamento de Cirugía Pediátrica, Hospital Infantil Vall d'Hebrón, Barcelona. conxbarcelo@yahoo.es
Irastorza
C Marhuenda
CM
Olivé
T
T
Montero
A Moreno
AM
Burrieza
G Guillén
GG
Gaethe
J A Molino
JA
Rocal
J Lloret
JL
Martínez-Ibáñez
V
V
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*