Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; University of Cincinnati, Cincinnati, OH, USA.
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center Cincinnati, OH, USA; University of Cincinnati, Cincinnati, OH, USA.
J Pediatr Surg. 2021 Nov;56(11):2073-2077. doi: 10.1016/j.jpedsurg.2020.12.020. Epub 2021 Jan 6.
BACKGROUND/PURPOSE: Pneumatosis intestinalis (PI) has been reported in hematopoietic stem cell transplant recipients (HSCT) since 1980s and at present there is no uniform consensus of the significance and management of this condition.
We retrospectively reviewed medical records of 990 consecutive pediatric HSCT recipients and examined data for clinical PI presentation, management and outcomes RESULTS: PI was identified in 53 patients (5.4%), mainly allogeneic HSCT recipients receiving systemic steroids. Abdominal X-ray was the main diagnostic modality. Forty-seven patients (89%) were evaluated because of clinical concerns and others were identified as incidental findings. Pneumoperitoneum was reported in 15 patients (28%). None of these patients had signs of acute abdomen. The majority of patients (43/53, 81%) had no targeted clinical intervention for PI and resolved PI in a median of 15 days (IQR 3-61). Surgery consult was only requested for 7/53 (13%) patients, three of whom had evidence of pneumoperitoneum. None of these patients required any surgical interventions.
Pneumatosis intestinalis commonly occurs in HSCT recipient receiving steroids, but unlike with NEC, PI rarely poses clinical risk after transplant. The majority of HSCT recipients with PI require only close monitoring without interventions. Surgical evaluation should be based on clinical symptoms and not PI presence alone.
背景/目的：自 20 世纪 80 年代以来，造血干细胞移植受者（HSCT）中就有报道出现肠气肿（PI），但目前对于这种情况的意义和处理方法尚无统一共识。
我们回顾性分析了 990 例连续接受 HSCT 的儿科患者的病历，并检查了 PI 的临床表现、处理和结局的数据。
53 例（5.4%）患者被诊断为 PI，主要为接受全身皮质类固醇治疗的异基因 HSCT 受者。腹部 X 线是主要的诊断方法。47 例（89%）患者因临床问题进行了评估，其余患者则为偶然发现。15 例（28%）患者有气腹。这些患者均无急性腹痛的迹象。大多数患者（43/53，81%）未对 PI 进行针对性的临床干预，PI 中位数在 15 天（IQR 3-61）内得到缓解。仅 7/53（13%）名患者请求外科会诊，其中 3 名患者有气腹证据。这些患者均无需进行任何外科干预。
皮质类固醇治疗的 HSCT 受者常发生 PI，但与 NEC 不同，PI 在移植后很少引起临床风险。大多数 PI 的 HSCT 受者仅需密切监测而无需干预。外科评估应基于临床症状，而不是单独的 PI 存在。
