ORIGINAL PAPER
Pneumatosis intestinalis as a complication of acute diarrhoea in children
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Submission date: 2018-06-17
Acceptance date: 2018-06-20
Publication date: 2018-08-30
Pediatr Pol 2018;93(4):291-297
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Pneumatosis of the intestine is often mentioned in the course of necrotising enterocolitis (NEC)
in premature infants.
Aim of the study:
The aim of the study was to assess the course of pneumatosis intestinalis in acute diarrhoea
and to analyse the factors in its development.
Material and methods:
The analysis included 10 children aged from three months to six years. All children
underwent abdominal ultrasound examination, which revealed pneumatosis of the intestine. The analysis
included pregnancy and delivery history, clinical symptoms, and the results of laboratory tests.
Results:
Bloody diarrhoea dominated the clinical picture in 9/10 patients (90%). Abnormal pregnancy/delivery
history was reported in six children. NEC was concluded in 3/10 children. Infections with rotavirus were
reported win 7/10 patients, Klebsiella pneumoniae were cultured in the stools of 4/10 children. Food allergy
was observed in 5/10 patients and immunoglobulin deficiency in three children.
Conclusions:
This study describes some cases of pneumatosis intestinalis as a complication following acute
diarrhoea, as observed in children below the age of 12 months. Abnormalities in pregnancy/delivery history,
low body mass, and co-occurrence of food allergy were the risk factors.
REFERENCES (31)
1.
Slesser A, Patel P, Das S, et al. A rare case of segmental small bowel pneumatosis intestinalis: A case report. Int J Surg Case Rep 2011; 2: 185-187.
2.
Snape J, Hulman G, Reddy P, Panto P. Pneumatosis coli: an uncommon but treatable cause of fecal incontinence. Int J Clin Pract 1998; 52: 501-503.
3.
Chavarri-Guerra Y, Jose Plata J, Cabrebere-Alexandrova T, Gamboa-Dominquez A. Pneumatosis intestinalis. Report of 3 cases. Rev Gastroenterol Mex 2000; 65: 166-170.
4.
Fukumori D, Sasaki T, Matsumoto H, et al. Necrotizing enteritis with hepatic portal venous gas and pneumatosis intestinalis: report of a case. Eur J Gastroenterol Hepatol 2003; 15: 201.
5.
Itazaki Y, Tsujimoto H, Ito N, et al. Pneumatosis intestinalis with obstructing intussusceptions: a case report and literature review. World J Gastrointest 2016; 8: 173-178.
6.
Agha RA, Fowler AJ, Rammohan S, et al. The PROCESS Statement: Preferred Reporting of Case Series in Surgery. Int J Surg 2016; 36 (Pt A): 319-323.
7.
Burgazli K, Mericliler M, Greiner H, et al. Pneumatosis intestinalis: a rare cause of lower gastrointestinal bleeding. Eur Rev Med Pharmacol Sci 2013; 17: 2293-2294.
8.
Dovrish Z, Amson Y, Amital H, Zissin R. Pneumatosis intestinalis presenting in autoimmine disease: a report of three patients. Ann N Y Acad Sci 2009; 1173: 199-202.
9.
Guha P, Handu A, Kanojia R, Rao K. Pneumatosis intestinalis and portal venous gas resulting from acute diarrheal illness: clinical picture in an infant. J Pediatr Surg 2011; 46: 271-273.
10.
Khalil P, Huber-Wagner S, Ladumer R, et al. Natural history, clinical pattern and surgical considerations of pneumatosis intestinalis. Eur J Med Res 2009; 14: 231-239.
11.
West K, Rescorla F, Grosfeld J, Vane D. Pneumatosis intestinalis in children beyond the neonatal period. J Pediatr Surg 1989; 24: 818-822.
12.
He T, Xu C, Ji Y, et al. Idiopathic neonatal pneumoperitoneum with favorable outcome: a case report and review. World J Gastroenterol 2015; 21: 6417-6421.
13.
Kyrieleis H, Wilsterman M, Severijnen R, et al. Pneumatosis intestinalis in 9 children with an oncologic disease. Ned Tijdschr Geneeskd 2005; 149: 647-652.
14.
Li S, Traubici J, Ethier M, et al. Pneumatosis intestinalis in children with acute lymphoblastic leukemia and acute myeloid leukemia. Support Care Cancer 2012; 20: 343-347.
15.
Wu L, Yang Y, Dou Y, Liu Q. A systematic analysis of pneumatosis cystoids intestinalis. World J Gastroenterol 2013; 19: 4973-4978.
16.
Ye X, Van J, Munoz F, et al. Noroviruses as a cause of diarrhea in immunocompromised pediatric hematopoetic stem cell and solid organ transplant recipients. Am J Transplant 2015; 15: 1874-1881.
17.
Kim JM, Park Y, Joh JW, et al. Pneumatosis intestinalis after adult liver transplantation. J Korean Surg Soc 2011; 80 (Suppl 1): 47-50.
18.
Shaukaut A, Obideen K, Klapproth J. Pneumatosis intestinalis: a rare cause of diarrhea and hematochezia. Clin Gastroenterol Hepatol 2006; 4: 25-28.
19.
Tahiri M, Levy J, Alzaid S, Anderson D. An approach to pneumatosis intestinalis: factors affecting your management. Int J Surg Case Rep 2015; 6C: 133-137.
20.
Bausch D, Hopt U, Obermaier R. Of what relevance is the diagnosis of pneumatosis intestinalis and portal gas for the surgeon? Zentralbi Chir 2009; 134: 203-208.
21.
Epelman M, Daneman A, Navarro OM, et al. Necrotising enterocolitis: review of the state-of-the-art imaging findings with pathologic correlation. Radiographics 2007; 27: 285-305.
22.
Silva CT, DanemanA, Navarro OM, et al. Correlation of sonographic findings and outcome in necrotizing enterocolitis. Pediatr Radiology 2007; 37: 274-282.
23.
Kamali K, Hosseini SR, Ardakani SM, Farnodi MR. Complementory Value of Sonography in Early Evaluation of Necrotizing Enterocolitis. Pol J Radiol 2015; 80: 317-323.
24.
Wang J, Furian A, Kaya D, et al. Pneumatosis intestinalis versus pseudo-pneumatosis: review of CT findings and differentiation. Insights Imaging 2011; 2: 85-92.
25.
Blair H, Baker R, Albazaz R. Pneumatosis intestinalis an increasingly common radiological finding, bening or life-threatening? A case series. BMJ Case Rep 2015; 2015: bcr2014207234.
26.
Bohnhorst B. Usefulness of abdominal ultrasound in diagnosing necrotizing enterocolitis. Arch Dis Fetal Neonatal Ed 2013; 98: 445-450.
27.
Ade-Ajayi N, Veys P, Stanton M, et al. Conservative management of pneumatosis intestinalis and pneumoperitoneum following bone-marrow transplantation. Pediatr Surg Int 2002; 18: 692-695.
28.
Al-Talib A, Al-Ghtani F, Munk R. Pneumatosis intestinalis: can we avoid surgical intervention in nonsurgical patients. Case Rep Gastroenterol 2009; 2: 286-292.
29.
Umapathi B, Friel C, Stukenborg G, Hedrick T. Estimating the risk of bowel ischemia requiring surgery in patients with tomographic evidence of pneumatosis intestinalis. Am J Surg 2016; 212: 762-768.
30.
Kameyarma K, Noguchi Y, Matsumoto T, et al. Pneumatosis intestinalis in a patient of myasthemia gravis treated with high-dose corticosteroid. Rinsho Shikeigaku 2003; 43: 277-280.
31.
Nidimusili A, Mennella J, Shaheen K. Small intestinal ischemia with pneumatosis in a young adult: what could be the cause? Case Rep Gastrointest Med 2013; 2013: 462985.