Resource utilization and surgical risk in pediatric pneumatosis intestinalis.
AI interpretation is pending for this paper.
Open original publication →What the AI sees
Not AI summarized yet.
Research significance
Pending deeper interpretation.
Source abstract
INTRODUCTION: Pneumatosis intestinalis (PI) in children, excluding necrotizing enterocolitis (NEC), is typically managed non-operatively with bowel rest, antibiotics, and total parenteral nutrition (TPN). However, guidance is limited on estimating the risk of requiring surgery, complicating decisions about the duration of non-operative medical treatment. This study aimed to assess the management of non-NEC PI and identify factors associated with surgical intervention. METHODS: A retrospective review was conducted of patients aged 6 months to 21 years diagnosed with PI from 2010 to 2023 at a free-standing children's hospital. Patients with NEC in the prior six months or abdominal surgery in the preceding three months were excluded. RESULTS: 102 patients (139 encounters) met inclusion criteria. Median age was 4.5 years; 29 % had genetic disorders, 22 % malignancies (17 on active treatment), and 13 % congenital heart disease. PI was identified via plain radiograph (71 %), CT (25 %), or both (4 %). In 16.5 % of cases, PI was an incidental finding. Antibiotics were used in 91 % of encounters and gastric decompression in 83 %. Surgery was required in 5 patients (3.6 %) due to radiologic progression (100 %), worsening pain/distention (100 %), fevers (60 %), and tachycardia (60 %). All surgical cases involved colonic PI and complex comorbidities. Four patients underwent bowel resection; two had colonic necrosis, and two had resections for underlying motility disorders. CONCLUSION: Surgery for non-NEC pediatric PI was rare and associated with colonic involvement, fever, tachycardia, and comorbidities. Most cases resolved with a brief course of medical management. Identifying high-risk features may help reduce unnecessary treatment in low-risk patients. LEVEL OF EVIDENCE: III.