WYS Lui, ACW Lee, YC Wong, KT So

Abstract

A 21-month-old boy with newly diagnosed acute lymphoblastic leukaemia had Rotavirus gastroenteritis during the first two weeks of induction chemotherapy. During the third week of treatment, he developed status epilepticus and progressive abdominal distention simultaneously. The former was precipitated by severe hyponatraemia associated vincristine induced syndrome of inappropriate anti-diuretic hormone. Typical radiological features of pneumatosis cystoides intestinalis were also recognised with the presence of free intra-abdominal gas. Despite the signs of an acute abdomen, an exploratory laparotomy did not reveal any bowel perforation. The child eventually recovered on intensive supportive care. Pneumatosis cystoides intestinalis is a rare but significant complication in immunocompromised patients. Laparotomy is usually not beneficial even in the presence of free intra-abdominal gas.