{
  "abstract": "We present the case of a 17-year-old boy with a known case of: Alexander disease, Haemophilia A, epilepsy and Gastrojejunostomy (GJ) feeding. He was admitted to the Emergency Department (ED) with a two-day history of worsening abdominal distention and left sided abdominal tenderness. Initial laboratory tests revealed a raised White Cell Count and CRP (64). Abdominal X-ray (AXR) demonstrated significant large bowel distension ( figure 1) and a subsequent Computed Tomography (CT) indicated distended large bowel loops with a prominent caecum, pneumatosis and small pneumoperitonem. Importantly, the degree of pneumoperitoneum and clinical presentation did not indicate bowel perforation.The patient was managed conservatively with broad-spectrum antibiotics, gastric decompression, and placement of a flatus tube. The jejunal tube was placed on free drainage. The patient had experienced a similar episode several months prior, which was also treated conservatively.Over the following 5 days, his abdominal distension and gastric aspirates decreased. A Peripherally Inserted Central Catheter (PICC) line was inserted, and feeds were gradually reintroduced.Eight weeks later, the patient returned to the ED with recurrent vomiting and worsening abdominal distension. Repeat AXR and CT imaging revealed worsening large bowel dilation, persistent right colonic pneumatosis, pneumoperitoneum, and a small amount of free fluid.Multidisciplinary team discussions were held both regionally and at super specialist level to formulate the best mode of treatment for this complex patient. It was agreed to continue with a conservative approach.This was well tolerated, and the patient‘s condition improved. The elemental feed was reintroduced, and progressively increased.Abstract OC41 Figure 1AXR - large bowel distension - a) First b) Second presentation c) CT findings of Pneumatosis intestinalisOn all occasions, the patient’s condition was successfully managed conservatively.This case highlights the increasing incidence of similar presentations, and the complexities involved in treating patients with neurological impairment and gastric dysmotility. Conservative management of PC should be considered in paediatric patients with neurological disabilities, intestinal dysmotility, and those dependent on long-term feeding tubes. Elective surgical treatment may be warranted in selected cases for recurrent episodes of PC who fail conservative treatment.1 2 Given the variability in the literature regarding the management of PC, and the recurrent nature of the condition in this cohort of patients, the development of clinical practice guidelines at regional, national, and international levels should be considered to ensure a standardized, conservative approach to care.References Galea J, Burnand K, Dawson F, et al. Pneumoperitoneum in the setting of pneumatosis intestinalis in children: is surgery always indicated? Eur J Pediatr. 2017;27:12–15.Reynolds HL Jr, Gauderer MWL, Hrabovsky EE, et al. Pneumatosis cystoides intestinalis in children beyond the first year of life: manifestations and management. J Paediatric Surg. 1991;26(12):1376–1380.",
  "authors": [
    {
      "affiliations": [
        "Royal Alexandra Children Hospital"
      ],
      "name": "Sarah Ellul"
    },
    {
      "affiliations": [
        "Royal Alexandra Children Hospital"
      ],
      "name": "Haitham Abul-Eis"
    },
    {
      "affiliations": [
        "Royal Alexandra Children Hospital"
      ],
      "name": "Jigna Sheth"
    },
    {
      "affiliations": [
        "Royal Alexandra Children Hospital"
      ],
      "name": "Farrah M Barrakat"
    }
  ],
  "title": "OC41 Management strategies for recurrent idiopathic pneumatosis coli",
  "uid": "83aa8629-5b70-5b9e-ba73-f1bd5c687383"
}