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Weber NT, Ogle S, Cooper EH, Kaizer AM, Kulungowski AM, Acker SN. Low-risk pneumatosis intestinalis in the pediatric surgical population. Pediatr Surg Int 2024; 40:76. [PMID: 38466447 DOI: 10.1007/s00383-024-05642-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Pneumatosis intestinalis (PI, presence of air in bowel wall) develops in a variety of settings and due to a variety of insults which is then characterized by varying severity and clinical course. Anecdotally, many of these cases are benign with few clinical sequelae; however, we lack evidence-based guidelines to help guide management of such lower-risk cases. We aimed to describe the clinical entity of low-risk PI, characterize the population of children who develop this form of PI, determine if management approach or clinical outcomes differed depending on the managing physician's field of practice, and finally determine if a shortened course of NPO and antibiotics was safe in the population of children with low-risk PI. METHODS We performed a retrospective review of all children over age 1 year treated at Children's Hospital Colorado (CHCO), between 2009 and 2019 with a diagnosis of PI who did not also have a diagnosis of cancer or history of bone marrow transplant (BMT). Data including demographic variables, clinical course, and outcomes were obtained from the electronic medical record. Low-risk criteria included no need for ICU admission, vasopressor use, or urgent surgical intervention. RESULTS Ninety-one children were treated for their first episode of PI during the study period, 72 of whom met our low-risk criteria. Among the low-risk group, rates of complications including hemodynamic decompensation during treatment, PI recurrence, Clostridium difficile colitis, and death did not differ between those who received 3 days or less of antibiotics and those who received more than 3 days of antibiotics. Outcomes also did not differ between children cared for by surgeons or pediatricians. CONCLUSIONS Here, we define low-risk PI as that which occurs in children over age 1 who do not have a prior diagnosis of cancer or prior BMT and who do not require ICU admission, vasopressor administration, or urgent surgical intervention. It is likely safe to treat these children with only 3 days of antibiotic therapy and NPO. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Nell T Weber
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah Ogle
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA
| | - Emily H Cooper
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alexander M Kaizer
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Shannon N Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA.
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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A 9-year-old boy with severe motor and intellectual disabilities and prolonged abdominal distension. J Paediatr Child Health 2022; 58:363-364. [PMID: 35133035 DOI: 10.1111/jpc.2_15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 12/01/2022]
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Acker SN, Ogle S, Saifee J, Marks L, Kulungowski AM. Surgical management of recurrent idiopathic pneumatosis intestinalis in the pediatric population. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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De Groot Ta A, Farrell M, Dillman JR, Trout AT. Clinical Predictors and Outcomes for Recurrent Pneumatosis Intestinalis in Children: A Case Control Study. J Pediatr Gastroenterol Nutr 2021; 73:e87-e93. [PMID: 34183613 PMCID: PMC11097597 DOI: 10.1097/mpg.0000000000003216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Pneumatosis intestinalis (PI) is air collections within the wall of the intestine that can be associated with life threatening conditions. Recurrent episodes of PI have been reported; however, little is known about risks for recurrent disease. This study aims to identify predictors of recurrent PI and evaluate long-term outcomes in patients with recurrent PI. METHODS This retrospective case-control study evaluated patients, ages 6 months to 18 years, with imaging evidence of PI over a 30-month period. Images were analyzed by consensus to confirm PI. Recurrent PI was defined as new findings of PI after resolution by imaging and/or at least 1-month interval between episodes of PI. Univariate and multivariable analyses were performed using logistic regression, with significance set to P < 0.05. RESULTS Forty-six children were included. Recurrent PI occurred in 17 (37%) patients, with a total of 39 episodes. Predictors of recurrent PI all related to the segment of bowel involved with small bowel PI predictive of recurrent PI (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.01, 2.4) and colonic PI protective (OR 0.6; 95% CI 0.4, 0.87) after adjusting for age. Predictors for surgical intervention included cerebral palsy (OR 17; 95% CI 1.7, 167) and PI involving small bowel (OR 19; 95% 3.1, 114). CONCLUSION Location of PI is predictive of recurrence. Clinical outcomes were similar between groups with single episode and recurrent PI.
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Affiliation(s)
- Allison De Groot Ta
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael Farrell
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jonathan R. Dillman
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew T. Trout
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
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Higuchi Y, Namba T, Ebuchi Y, Nakahara Y, Takeuchi A. A 9-year-old boy with severe motor and intellectual disabilities and prolonged abdominal distension. J Paediatr Child Health 2021:jpc.15459. [PMID: 33772930 DOI: 10.1111/jpc.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Yousuke Higuchi
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takahiro Namba
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yuki Ebuchi
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yasuo Nakahara
- Department of Pediatric Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Akihito Takeuchi
- Department of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
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