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133

Case Report ,‘

Pneumatosis Carlos

J. Sivit,1’2 Shelby

Pneumatosis with many

ischemia, been

intestinalis

gastrointestinal

and obstruction.

described

in patients

Intestinalis H. Josephs,2’3

in Children

George

A. Taylor,1’2’4

has been described in association tract disorders, including infection, Pneumatosis with

intestinalis

obstructive

also has

pulmonary

Case Report A 1 6-month-old boy was admitted with a 2-day history of fever, bilious vomiting, and abdominal distension. Systemic manifestations of AIDS had been present for 10 months and included chronic cytomegalovirus infection and an episode of Candida esophagitis and

requiring

a gastrostomy.

Endoscopy

had not been

performed

recently. Physical examination revealed domen. Bowel sounds were increased.

a tender and distended abPlain films of the abdomen

demonstrated

diffusely

pneumatosis

intestinalis

involving

the large levels, or free intraperi-

bowel (Fig. 1). No bowel distension, air-fluid toneal air was present. The patient was treated with bowel rest and nutritional support. The pneumatosis intestinalis resolved within 3 days. Gastrointestinal signs and symptoms resolved in 1 week, and the patient was able to resume enteral feedings 1 0 days after the

resolution

of the pneumatosis

intestinalis.

The patient

and David C. Kushner1’2

7 months

isolated

later and has not had a recurrence.

from the blood or stool during

chronic

cytomegalovirus

No organisms

the hospitalization,

were

despite

infection.

dis-

ease, collagen-vascular diseases, leukemia, lymphoma, and various states of immunodeficiency [1 -4]. The significance of pneumatosis intestinalis in children with AIDS is unknown. In this report, we describe three children with AIDS who subsequently developed pneumatosis intestinalis.

gastritis

with AIDS

remains alive

Discussion Pneumatosis

intestinalis

is characterized

by the develop-

ment of submucosal or subserosal gas-filled lesions in the gastrointestinal tract. It may occur in isolation or in association with any of a variety of disorders [1 -4]. On radiographs of the abdomen, pneumatosis intestinalis may have a cystic or linear appearance. The cystic form is restricted to the colon and is usually seen with noncatastrophic conditions [5]. In contrast to the cystic form, the linear form may involve the entire gastrointestinal tract and has been more frequently implicated in conditions that result in bowel ischemia, bowel

necrosis, or severe mucosal destruction [5]. Disorders of the gastrointestinal tract in children are usually multifocal

a result bowel

organisms hypoxia,

of infection

infection

has been associated

[6-8].

caused

by a variety

described with severe

[6,

children

with pneumatosis

with AIDS or recurrent

of opportunistic

8]. In addition,

pulmonary

culitis, may be seen. In addition to the case reported other

Chronic

disease

bowel or vas-

here, we have seen two

intestinalis

and AIDS.

All had

systemic manifestations of AIDS for at least 10 months and had the following gastrointestinal tract symptoms when had

January 2, 1990; accepted after revision February 12, 1990. Department of Diagnostic Imaging and Radiology, Children’s Hospital National Medical Center and the George Washington University Schcol of Medicine and Health Sciences, 111 Michigan Aye, NW., Washington, DC 20010. 2 Department of Pediatrics, Children’s Hospital National Medical Center and the George Washington Liiiversity Schcol of Medicine, Washington, DC 20010. 3 Department of Allergy and Immunology, Children’s Hospital National Medical Center and the George Washington University School of Medicine, Washington, DC 20010. 4 Present address: Department of Radiology, The Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21205. Received I

AJR 155:133-134,

July 1990 0361-803x/90/1551-0133

C American Roentgen Ray Society

134

SIVIT

ET

AL.

AJR:155,July

Fig.

1.-Anteroposterior

1990

views

of

abdomen. A, Pneumatosis

Downloaded from www.ajronline.org by 174.29.180.64 on 11/08/15 from IP address 174.29.180.64. Copyright ARRS. For personal use only; all rights reserved

intestinalis diffusely involving large bowel. B, Linear pneumatosis involving ascending and proximal transverse colon.

pneumatosis intestinalis was identified: abdominal distension (two patients), pain (one patient), tenderness (one patient), bilious vomiting (one patient), and bloody diarrhea (one patient). Two of the children had viral infections (rotavirus, cytomegalovirus) and one had bacterial infection (Pseudomonas). Pneumatosis intestinalis was seen as the sole radiologic

abnormality

in all three patients.

and

to the

limited

colon

It was linear in appearance

in all patients.

The

patients

were

treated with fluid resuscitation, bowel rest, and nutritional support. The pneumatosis intestinalis resolved within 3 days, and enteral feedings were resumed within 2 weeks. None of the children had a recurrence of pneumatosis. Two of the children died of other complications 3 and 12 months after presenting with pneumatosis. In this small group of children with AIDS, pneumatosis intestinalis was not associated with a bowel catastrophe. Further studies are needed to elucidate the significance and

causes

of this event.

REFERENCES 1 . Mueller C, Morehead R, Alter A, Michener W. Pneumatosis intestinalis in collagen disorders. AJR 1972:115:300-305 2. Keats TE, Smith TH. Benign pneumatosis intestinalis in childhcod leukemia. AJR 1974:122:150-152

3. O’Connell DJ, Thompson AJ. Pneumatosis coli in non-Hodgkinslymphoma. Br J Radio! 1978:1:203-205 4. Kleinman PK, Brill PW, Winchester P. Pneumatosis intestinalis: its occurrence in the immunologically compromised child. Am J Dis Child 1980; 134:1149-1151 5. Rice RP. The plain film of the abdomen. In: Taveras JM, Ferrucci JT, eds. Radiology: diagnosis-imaging-intervention. Philadelphia: Lippincott, 1989: 1-21 6. Haney PJ, Yale-Loehr AJ, Nussbaum AR, Gellad FE. Imaging of infants and children with AIDS. AJR 1989;152: 1033-1 041 7. McLoughlin LC, Nord KS, Joshi vv, Oleske JM, Connor EM. Severe gastrointestinal involvement in children with acquired immunodeficiency syndrome. J Pediatr Gastroenterol Nutr 1987;6:517-524 8. Bradford BF, Abdenour GE, Frank JL, Scott GB, Beeman R. Usual and unusual radiologic manifestations of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection in children. Radio! Clin North Am 1988;26:341-353