Researchers studied 102 children who developed pneumatosis intestinalis—a condition where air gets trapped in the intestinal walls. This is different from a more serious condition called necrotizing enterocolitis. Most children got better with rest, antibiotics, and IV nutrition without needing surgery. Only 3.6% of cases required an operation, and those were mostly children with other serious health conditions. The study helps doctors figure out which children might need surgery and which ones will likely recover with medical treatment alone.

The Quick Take

  • What they studied: How often children with air pockets in their intestines need surgery, and what signs might mean surgery is necessary
  • Who participated: 102 children aged 6 months to 21 years treated at a children’s hospital between 2010-2023. About 29% had genetic disorders, 22% had cancer, and 13% had heart problems
  • Key finding: Only 5 out of 139 cases (3.6%) required surgery. All surgical cases involved the large intestine and children with multiple health problems. Most children recovered with bowel rest, antibiotics, and IV nutrition
  • What it means for you: If your child is diagnosed with this condition, there’s a good chance they’ll recover without surgery. However, doctors should watch carefully for warning signs like fever, rapid heartbeat, and worsening belly pain, especially if the air is in the large intestine

The Research Details

Doctors reviewed medical records of children treated at one children’s hospital over 13 years. They looked back at cases from 2010 to 2023 to see who needed surgery and who didn’t. They excluded children who had recently had necrotizing enterocolitis (a different, more serious bowel condition) or recent abdominal surgery, since those would complicate the results.

The researchers collected information about each child’s age, other health conditions, how the air pockets were found (X-ray or CT scan), what treatments they received, and whether they eventually needed surgery. They then compared the children who needed operations with those who recovered without surgery to find patterns.

This research approach is important because it looks at real-world cases rather than just theory. By studying what actually happened to these children, doctors can learn which warning signs mean a child might need surgery and which children are likely to get better with just medical treatment. This helps doctors make better decisions about how long to try non-surgical treatment before considering an operation.

This study looked back at past medical records, which is less reliable than following patients forward in time. The study was done at one hospital, so results might be different at other hospitals. However, the large number of cases (102 patients with 139 separate episodes) and long time period (13 years) make the findings fairly reliable. The researchers were careful to exclude cases that would confuse the results.

What the Results Show

Out of 139 cases of air pockets in the intestines, only 5 children (3.6%) needed surgery. This means that most children—about 96%—got better without an operation. The air pockets were found using regular X-rays in 71% of cases, CT scans in 25%, or both in 4%. Interestingly, in about 1 out of 6 cases, the air pockets were found by accident while doctors were looking for something else.

Almost all children (91%) received antibiotics, and most (83%) had a tube placed through their nose to drain their stomach. These simple treatments, combined with letting the bowel rest and giving nutrition through an IV, worked for the vast majority of cases.

The 5 children who did need surgery all had air pockets in their large intestine (colon), not the small intestine. All of them also had other serious health problems. Four children had part of their bowel removed—two because the tissue died and two because of movement problems in their intestines. The warning signs that appeared in children who needed surgery included the air pockets getting worse on imaging, increasing belly pain and swelling, fever, and a racing heartbeat.

The study found that children with genetic disorders, cancer, or heart problems made up a large portion of the group (29%, 22%, and 13% respectively). However, having these conditions didn’t automatically mean a child would need surgery. The key difference was whether the air pockets were in the large intestine and whether the child developed fever and a racing heartbeat. Children whose air pockets were found by accident (not because they were sick) all recovered without surgery.

This study confirms what doctors have suspected: most cases of air pockets in the intestines in children can be treated without surgery. The finding that only 3.6% need operations is consistent with other smaller studies. The study adds new information by showing that colonic involvement (large intestine) and signs of infection (fever, rapid heartbeat) are the main warning signs for surgery.

This study looked backward at medical records, so doctors couldn’t control how children were treated or follow them as carefully as in a planned experiment. The study was done at one hospital, so the results might be different at other hospitals with different patient populations or treatment approaches. The study didn’t have a comparison group of children treated differently, so we can’t say for certain that the medical treatment caused the recovery. Some information might be missing from old medical records.

The Bottom Line

If your child is diagnosed with air pockets in the intestines (pneumatosis intestinalis), doctors should try medical treatment first with bowel rest, antibiotics, and IV nutrition. This approach works for about 96% of cases. However, doctors should watch carefully for warning signs: worsening belly pain and swelling, fever, and a racing heartbeat. If these develop, especially if the air is in the large intestine, surgery may be needed. This recommendation is based on solid evidence from real patient cases, though more research would strengthen it.

Parents of children diagnosed with air pockets in the intestines should understand that surgery is usually not necessary. Children with other serious health conditions (genetic disorders, cancer, heart problems) should be monitored more carefully. Doctors should use this information to avoid unnecessary surgery in low-risk cases while staying alert for children who might need it. This information is less relevant for children with necrotizing enterocolitis, which is a different, more serious condition.

Most children who recover without surgery do so within days to a few weeks of starting medical treatment. The study didn’t specify exact timelines, but the focus on ‘brief course of medical management’ suggests improvement happens relatively quickly. If a child isn’t improving after several days or develops warning signs, surgery may become necessary.

Want to Apply This Research?

  • If your child has been diagnosed with this condition, track daily: belly pain level (1-10 scale), presence of fever (temperature), heart rate if possible, and any changes in bowel movements or feeding tolerance. Note any imaging results and medication changes
  • Work with your medical team to follow the prescribed bowel rest period and medication schedule exactly. Keep detailed notes of any symptoms that develop, especially fever or increased belly pain, so you can report them immediately to your doctor. This helps doctors catch warning signs early
  • Set daily reminders to check for and log fever, belly pain, and feeding tolerance. Create alerts for any concerning symptoms to discuss with your doctor. After discharge, continue monitoring for 2-4 weeks and report any return of symptoms immediately

This summary is for educational purposes only and should not replace professional medical advice. Pneumatosis intestinalis requires diagnosis and management by qualified healthcare providers. If your child has symptoms like severe belly pain, fever, vomiting, or abdominal distention, seek immediate medical attention. Treatment decisions should be made with your child’s doctor based on their individual condition, imaging results, and overall health status. This research represents one hospital’s experience and may not apply to all children or settings.