Vol. 3, Issue 2 (2017)
Pneumatosis intestinalis in a cohort of children with neurological impairment: A patients group with a management dilemma
Author(s): Dr. Devanshu Kumar, Dr. CB Kumar
Abstract: Introduction: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. Method: We retrospectively studied all school-age children who were referred to paediatric surgeons with radiological evidence of PI identified between 2015 and November 2016. We analysed data on patient demographics, medications, feeding, associated comorbidities, presentation, investigations and treatments. Main results: neurologically impaired Five patients with a median age of 7 years (range 5-9) were referred for surgical opinion with evidence of PI on their abdominal xrays. Four of the patients had an associated pneumoperitoneum. Interestingly, all patients had cerebral palsy, such that they were significantly neurologically impaired and unable to communicate clearly. Four patients had a laparoscopy/laparotomy at first presentation, with no findings of ischaemic bowel, peritoneal soiling or perforation despite the prescence of pneumoperitoneum on xrays, however, obvious colonic pneumatosis was seen. Four patients were gastrostomy fed, one was jejunally fed. Three patients were medically treated for constipation and two for chronic lung disease (CLD). Four patients had subsequent presentations, which were successfully managed without surgical intervention, despite the prescence 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.