Pneumoperitoneum in the Setting of Pneumatosis Intestinalis in Children: Is Surgery Always Indicated?
AimPneumatosis intestinalis (PI) is a condition in which multiple gas-filled cysts form within the wall of the gastrointestinal tract in either the subserosa or submucosa. The presence of pneumoperitoneum in the presence of PI can present a therapeutic dilemma. The aim of our study was to review our experience and management of this condition.MethodsA single-center retrospective study of consecutive children (> 1 year) presenting with a pneumoperitoneum and evidence of PI (2009-2015). Demographics, case notes, microbiology, and imaging were reviewed.ResultsSeven patients were identified (four males; age range 5-14 years). Four children had global developmental delay and were percutaneous endoscopic gastrostomy or jejunostomy fed, one was immunocompromised (acute lymphoblastic leukemia). The others had encephalitis and eosinophilic gastroenteritis. One patient proceeded to an exploratory laparotomy; no perforation was identified, pneumatosis of the colon was observed, and a loop ileostomy was formed. The remaining six were managed conservatively and made nil by mouth with intravenous antibiotics commenced. Five of the six had a computed tomography (CT) scan which revealed PI and free air with no other worrying signs. One died from nongastrointestinal causes, while the remaining five had feeds reintroduced uneventfully.ConclusionFree air in the setting of PI may represent rupture of the gas cysts and not always transmural perforation. Surgery may not always be indicated and conservative management may suffice. A CT scan can be useful for excluding other intra-abdominal pathological findings and continued clinical assessment is essential.
Department of Paediatric Surgery, St George's Hospital, London, United Kingdom.
Julie
J
Galea
Department of Paediatric Surgery, St George's Hospital, London, United Kingdom.
Katherine M
KM
Burnand
Department of Paediatric Surgery, St George's Hospital, London, United Kingdom.
Fiona L
FL
Dawson
Department of Paediatric Surgery, St George's Hospital, London, United Kingdom.
Chandrasen K
CK
Sinha
Department of Paediatric Surgery, St George's Hospital, London, United Kingdom.
Dean
D
Rex
Department of Paediatric Surgery, St George's Hospital, London, United Kingdom.
Bruce O
BO
Okoye
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D000072700:Conservative Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011006:Pneumatosis Cystoides Intestinalis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome