Abstract
Aim Pneumatosis 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.
Methods A 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.
Results Seven 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.
Conclusion Free 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.
Keywords
pneumatosis intestinalis - pneumoperitoneum - conservative management
