Pneumatosis Intestinalis Management

Initial Assessment and Risk Stratification

• In neonates with necrotizing enterocolitis, peritoneal drainage may be used for bowel perforation in very low birth weight infants, though some surgeons advocate bowel resection with stoma creation or reanastomosis, with nonoperative management succeeding approximately 70% of the time 1

Surgical Indications

• Portal venous gas can be an indication for immediate surgical exploration, although it can occasionally be benign 1

Antibiotic Selection

• The Infectious Diseases Society of America (IDSA) recommends carbapenems (imipenem, meropenem, or ertapenem) for empiric broad-spectrum coverage in pneumatosis with suspected infection 1, 2
• The IDSA also recommends piperacillin-tazobactam as an alternative for empiric broad-spectrum coverage in pneumatosis with suspected infection 1, 2
• For neutropenic enterocolitis, the IDSA guidelines suggest monotherapy with anti-pseudomonal β-lactam (piperacillin-tazobactam or carbapenem) as first choice 3