Pneumatosis intestinalis (PI) is a well-recognized manifestation of
necrotizing enterocolitis (NEC) in the newborn--a condition that often requires surgical intervention for infarcted bowel. However, little information is available concerning PI in older children or its management. Sixteen older infants and children (greater than 2 months) had x-ray findings of PI (intramural air). There were eight girls and eight boys ranging in age from 2 months to 8 years. Associated conditions included
short bowel syndrome (SBS) (8),
congenital heart disease (2),
iron ingestion (1),
nesidioblastosis (1),
hemolytic anemia (1),
rheumatoid arthritis (1),
bronchopulmonary dysplasia (BPD) (1), and malrotation (1). Clinical presentation included abdominal distension (13), bloody
diarrhea (12), bilious
emesis (5), and
lethargy (5). Two patients on
steroids had unsuspected PI identified as an incidental operative finding during
pancreatectomy for
nesidioblastosis (1) and
splenectomy for
hemolytic anemia (1), respectively. Only four other children (
iron toxicity, postcardiac catheterization,
rheumatoid arthritis, and BPD required surgical intervention. Each manifested peritioneal irritation,
acidosis, and
hypotension or had
pneumoperitoneum on abdominal x-ray. In ten of 14 patients, PI was managed nonoperatively with nasogastric suction, fluid
resuscitation, intravenous (IV)
antibiotics (seven to ten days), and repeated abdominal x-ray and physical examinations. Children with SBS comprised 50% of the total number of patients and eight of ten treated by observation. All had associated viral syndromes (rotavirus) or rhotozyme-positive stools and developed bloody
diarrhea. There were two deaths (12.5%) in patients with
iron toxicity and
congenital heart disease who required resection of gangrenous bowel. All of the other patients survived.(ABSTRACT TRUNCATED AT 250 WORDS)