Pneumatosis intestinalis in a cohort of children with neurological impairment: A patient group with a management dilemma

Abstract

Aim: Pneumatosis intestinalis (PI) is uncommon in school-age children. We studied a cohort of neurologically impaired school-age children with PI to formulate an optimum management plan.

Methods: We retrospectively studied all school-age children who were referred to paediatric surgeons with radiological evidence of PI identified between 2011 and 2015. We analysed data on patient demographics, medications, feeding, associated comorbidities, presentation, investigations and treatments.

Results: Five patients (3F:2M) with a median age of 7 years (range 5-9) were referred for surgical opinion with the evidence of pneumatosis on their abdominal X-rays. Four of them had associated pneumoperitoneum. All children had neurological impairment significant enough to make them unable to communicate clearly. Four patients were gastrostomy fed, one was jejunally fed. Four children had recurrent episodes of pneumatosis. Four patients had surgery at the initial presentation where colonic pneumatosis was detected; however, there was no evidence of bowel ischaemia or perforation despite of the presence of pneumoperitoneum. Recurrent episodes were successfully managed conservatively even in the presence of pneumoperitoneum.

Conclusion: In neurologically impaired school-age children, the presence of pneumatosis and pneumoperitoneum does not mandate bowel ischaemia or perforation and therefore could be successfully managed conservatively without the need for surgery.

Keywords: laparoscopy; laparotomy; neurological impairment; pneumatosis intestinalis; pneumoperitoneum; tube feeding.