title: Pneumatosis intestinalis in children with acute lymphoblastic leukemia and acute myeloid leukemia.
abstract: OBJECTIVE
  To describe symptoms, diagnostic features, treatments, and outcomes of pneumatosis intestinalis (PI) in pediatric patients being treated for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).
  
  
  METHODS
  This retrospective chart review included 514 patients ≤ 18 years of age diagnosed with ALL or AML between January 1999 and December 2007. PI episodes were identified by radiology report reviews.
  
  
  RESULTS
  Twenty patients with ALL and four patients with AML presented 31 PI episodes. The median time between diagnoses of leukemia and PI was 1.0 month (interquartile range 0.8-6.4 months). Plain radiographs diagnosed all PI episodes. Computerized tomography (CT) and ultrasound were performed in 6 and 13 episodes, respectively. All CT and three ultrasounds demonstrated PI. Thirty episodes occurred exclusively in the colon, most commonly in the ascending (n = 26) and transverse (n = 18) segments. Treatment included complete bowel rest in 27 (87.1%) and intravenous broad-spectrum antibiotics in 29 (93.5%). One case required colectomy. Two episodes were untreated. There were no fatalities associated with PI.
  
  
  CONCLUSIONS
  PI is uncommon in children with ALL or AML. Ultrasound is less sensitive than plain radiographs for diagnosis. PI occurred almost exclusively in the colon. With conservative management, most patients had excellent outcome.
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Siyang
authors.initials: S
authors.lastname: Li
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Traubici
authors.forename: Marie-Chantal
authors.initials: MC
authors.lastname: Ethier
authors.forename: Biljana
authors.initials: B
authors.lastname: Gillmeister
authors.forename: Sarah
authors.initials: S
authors.lastname: Alexander
authors.forename: Adam
authors.initials: A
authors.lastname: Gassas
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D011006:Pneumatosis Cystoides Intestinalis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents