De Groot Ta et al evaluated pediatric patients with pneumatosis intestinalis (PI). They identified patients who may require more aggressive management. The authors are from Cincinnati Children's Hospital and the University of Cincinnati.
Pneumatosis intestinalis (PI) is uncommon after the neonatal period.
For patients older than 6 months of age, risk factors were:
(1) cerebral palsy
(2) therapy with immunosuppressive drugs
In the study recurrent PI occurred in 37% of patients. PI involving the small intestine is more likely to be recurrent.
The patient may present with new or persistent:
(1) feeding intolerance
(2) abdominal distention
The pneumatosis is diagnosed if detected in imaging studies.
Risk factors for surgical intervention:
(1) cerebral palsy
(2) involvement of the small intestine
If the patient has extraluminal air and is clinically unstable, then emergency surgery may be indicated.
Indications for surgical consult:
(1) extraluminal air and clinically stable
(2) peritoneal symptoms
(3) abnormal laboratory tests
(4) clinical deterioration
