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• W2912663488 abstract "An abdominal radiograph of a 17-month-old patient demonstrates intramural bowel gas consistent with pneumatosis intestinalis (Figure). The patient recently had undergone successful bone marrow transplantation as treatment for Wiskott-Aldrich syndrome, an X-linked immune deficiency characterized by thrombocytopenia, susceptibility to pyogenic infections, and eczema. As is often the case in benign pneumatosis intestinalis, the diagnosis here was an incidental radiologic one and was ascribed to increased mucosal permeability attributable to immunosuppression. Infection is known to play an important pathophysiologic role in the development of pneumatosis intestinalis1Vendryes C. Hunter C.J. Harlan S.R. Ford H.R. Stein J. Pierce J.R. Pneumatosis intestinalis after laparoscopic appendectomy: case report and review of the literature.J Pediatr Surg. 2011; 46: e21-e24Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar and is particularly relevant in the context of immunosuppression, where patients are treated with chemotherapy and/or steroids often in the aftermath of organ transplantation or for the treatment of hematological malignancies.2McCarville M.B. Whittle S.B. Goodin G.S. Li C.S. Smeltzer M.P. Hale G.A. et al.Clinical and CT features of benign pneumatosis intestinalis in pediatric hematopoietic stem cell transplant and oncology patients.Pediatr Radiol. 2008; 38: 1074-1083Crossref PubMed Scopus (21) Google Scholar Bacteria penetrate the bowel mucosa and produce the intramural gas, as seen extensively in this abdominal radiograph (Figure). Importantly in this nonischemic category, the submucosal gas cysts tend to resolve spontaneously without causing perforation. Another important nonischemic association in children is inflammatory bowel disease, where mucosal ulceration allows gas to enter the bowel wall. Rarely, mechanical causes may be implicated, for example following endoscopy.1Vendryes C. Hunter C.J. Harlan S.R. Ford H.R. Stein J. Pierce J.R. Pneumatosis intestinalis after laparoscopic appendectomy: case report and review of the literature.J Pediatr Surg. 2011; 46: e21-e24Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Pneumatosis, however, can be a more ominous finding in necrotizing enterocolitis or ischemic enteritis, where intramural gas forms as a result of bowel wall necrosis. In such cases, gas collections typically are linear and can be transmural. Other important radiographic findings in such scenarios may include pneumoperitoneum and portal venous gas. Computed tomography imaging may help to point towards an ischemic etiology by demonstrating additional features such as bowel wall thickening and abnormal enhancement patterns. In these situations, the onus is on prompt diagnosis and surgical assessment. Ultimately, benign and serious pneumatosis can be difficult to differentiate by plain radiographs alone, and therefore consideration of the clinical context is essential." @default.
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• W2912663488 date "2014-09-01" @default.
• W2912663488 modified "2023-09-27" @default.
• W2912663488 title "Pneumatosis Intestinalis" @default.
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• W2912663488 doi "https://doi.org/10.1016/j.jpeds.2014.05.017" @default.
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