Nonoperative Management of Pneumatosis Intestinalis and Pneumoperitoneum in a Patient with Acute Lymphoblastic Leukemia: Case Report and Review of the Literature

Introduction

Pneumoperitoneum (PP) in the absence of intra-abdominal catastrophe is a rare entity described in non-neonatal children with leukemia [1] [2] [3] [4] [5] [6] [7] [8] [9], immune deficiency diseases, hematological disorders [1] [6] [10], or other chronic disease processes [6]. The free air is theorized to be produced by ruptured pneumatoceles present in pneumatosis intestinalis (PI). The nonoperative management of patients with pneumoperitoneum, although previously described in the references cited above as successful in selected cases, is controversial in the literature and debatable in clinical practice. We present a case report of a child with acute lymphoblastic leukemia who presented with pneumatosis intestinalis and pneumoperitoneum and was managed nonoperatively. We reviewed the literature with the aim of delineating the circumstances under which children with these findings may be conservatively managed with a period of close observation, perhaps avoiding the morbidity associated with surgery.

References

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