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Weber NT, Ogle S, Cooper EH, Kaizer AM, Kulungowski AM, Acker SN. Low-risk pneumatosis intestinalis in the pediatric surgical population. Pediatr Surg Int 2024; 40:76. [PMID: 38466447 DOI: 10.1007/s00383-024-05642-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Pneumatosis intestinalis (PI, presence of air in bowel wall) develops in a variety of settings and due to a variety of insults which is then characterized by varying severity and clinical course. Anecdotally, many of these cases are benign with few clinical sequelae; however, we lack evidence-based guidelines to help guide management of such lower-risk cases. We aimed to describe the clinical entity of low-risk PI, characterize the population of children who develop this form of PI, determine if management approach or clinical outcomes differed depending on the managing physician's field of practice, and finally determine if a shortened course of NPO and antibiotics was safe in the population of children with low-risk PI. METHODS We performed a retrospective review of all children over age 1 year treated at Children's Hospital Colorado (CHCO), between 2009 and 2019 with a diagnosis of PI who did not also have a diagnosis of cancer or history of bone marrow transplant (BMT). Data including demographic variables, clinical course, and outcomes were obtained from the electronic medical record. Low-risk criteria included no need for ICU admission, vasopressor use, or urgent surgical intervention. RESULTS Ninety-one children were treated for their first episode of PI during the study period, 72 of whom met our low-risk criteria. Among the low-risk group, rates of complications including hemodynamic decompensation during treatment, PI recurrence, Clostridium difficile colitis, and death did not differ between those who received 3 days or less of antibiotics and those who received more than 3 days of antibiotics. Outcomes also did not differ between children cared for by surgeons or pediatricians. CONCLUSIONS Here, we define low-risk PI as that which occurs in children over age 1 who do not have a prior diagnosis of cancer or prior BMT and who do not require ICU admission, vasopressor administration, or urgent surgical intervention. It is likely safe to treat these children with only 3 days of antibiotic therapy and NPO. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Nell T Weber
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah Ogle
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA
| | - Emily H Cooper
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alexander M Kaizer
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Shannon N Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA.
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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Spencer BL, Aaron B, Imel S, Hirschl RB, Gadepalli SK. Non-Operative Management of Children with Pneumatosis Intestinalis Beyond the Neonatal Period: Opportunity to Decrease Resource Utilization, a Single Center Experience. J Gastrointest Surg 2023; 27:3074-3075. [PMID: 37670108 DOI: 10.1007/s11605-023-05828-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/31/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Brianna L Spencer
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II B560, Ann Arbor, MI, USA.
| | - Bryan Aaron
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II B560, Ann Arbor, MI, USA
| | - Sydni Imel
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II B560, Ann Arbor, MI, USA
| | - Ronald B Hirschl
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II B560, Ann Arbor, MI, USA
| | - Samir K Gadepalli
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II B560, Ann Arbor, MI, USA
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Acker SN, Ogle S, Cooper E, Meier M, Peterson PN, Kulungowski AM. Current approaches to the management of pneumatosis intestinalis: an American Pediatric Surgical Association membership survey. Pediatr Surg Int 2022; 38:1965-1970. [PMID: 36242600 DOI: 10.1007/s00383-022-05249-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Pneumatosis intestinalis (PI) remains difficult to treat as it can lead to a broad range of clinical sequalae and there are little published data available to guide management. Our aim was to evaluate how pediatric surgeons currently manage children with PI, how treatment varies based on etiology, and to identify opportunities to optimize current PI management strategies. METHODS We administered a web-based survey of practicing pediatric surgeons in the United States and Canada. The survey was distributed to all members of the American Pediatric Surgical Association. RESULTS Of 1508 distributed surveys, 333 responses were received (22% response rate); 174 were complete and included in analysis (12% analyzed). For all scenarios, respondents recommended treatment for PI include a median 7 days of bowel rest and 7 days antibiotics. Only 41% reported their approach to PI management was optimal. Ways to optimize care include treatment based on etiology (83%), decreased number of repeat images (64%), shorter NPO course (49%), and shorter antibiotic course (47%). CONCLUSION Pediatric surgeons manage PI similarly regardless of etiology but most report this is suboptimal. Future work is needed to prospectively evaluate management protocols that consider etiology.
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Affiliation(s)
- Shannon N Acker
- Division of Pediatric Surgery, Anschutz Medical Campus, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Box 323, Aurora, CO, 80045, USA.
| | - Sarah Ogle
- Division of Pediatric Surgery, Anschutz Medical Campus, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Box 323, Aurora, CO, 80045, USA
| | - Emily Cooper
- Research Outcomes in Children's Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Maxene Meier
- Research Outcomes in Children's Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Pamela N Peterson
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, CO, USA
- Division of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Anschutz Medical Campus, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Box 323, Aurora, CO, 80045, USA
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