Pneumatosis Intestinalis in Pediatric Oncology

Pneumatosis intestinalis (PI) is a radiographic finding describing the presence of gas within the submucosal and subserosal layers of the intestinal wall. Whereas PI can be an ominous finding in some disease states, PI is often seen in asymptomatic or minimally symptomatic pediatric oncology patients who fully recover, even with little specific therapy. Several recent single institution reviews of pediatric oncology patients with PI have been conducted. Taken together, these studies indicate that most pediatric oncology patients with PI clinically do well and rarely require surgical intervention. Data are solely from single institution studies, however, and highlight a heterogenous approach to patient management that most respondents to a survey from the American Pediatric Surgical Association believe is suboptimal. The present study aims to better understand approaches to treatment, incidence of surgical intervention, and outcomes for pediatric oncology patients presenting with PI. Conducting a multi-institutional study should allow for an analysis based on important subgroups including patients with a history of hematopoietic stem cell transplant (HSCT), patients receiving steroids, and patients with pneumoperitoneum. The primary outcome is time to recovery from PI, defined as the time from initial PI diagnosis to the first of diet advancement, de-escalation of antibiotics, or resolution of PI on imaging. Secondary outcomes include the 30-day mortality rate associated with PI and the incidence of surgical intervention for PI within 30 days of diagnosis. An exploratory analysis will additionally be conducted to determine risk factors associated with the need for surgical intervention. The project ultimately aims to produce a management algorithm for this disease process in the pediatric oncology setting.

Study Investigators: Andrew Davidoff, MD and Zach Morrison, MD

Contact Chloé Boehmer (Chloe.Boehmer@cchmc.org) if you have questions on how to participate in this study at a PSORC institution.

Pneumatosis intestinalis (white oval) in a 3-year-old female with a history of acute myeloid leukemia.