Can Bilateral Pneumonia Cause Ileus in a Child?
Yes, bilateral pneumonia can cause ileus in a pediatric patient, though this is an uncommon complication that occurs when lower lobe pneumonia triggers abdominal symptoms through inflammatory irritation of the diaphragm and peritoneum.
Mechanism and Clinical Evidence
The connection between pneumonia and ileus in children is well-documented, particularly with basilar (lower lobe) pneumonia:
- Lower lobe pneumonia can simulate acute abdominal conditions including appendicitis, with associated ileus that resolves once antibiotic therapy is initiated 1
- This phenomenon occurs with both right-sided and left-sided pneumonia, contrary to the common belief that only right-sided pneumonia causes abdominal symptoms 1
- The abdominal symptoms and ileus typically subside soon after starting appropriate antibiotics, confirming the pneumonia as the primary cause 1
Pathophysiologic Considerations
The mechanism involves:
- Diaphragmatic irritation from adjacent inflamed lung parenchyma, particularly in bilateral lower lobe involvement
- Inflammatory mediators from severe systemic infection affecting gastrointestinal motility
- Systemic complications of severe pneumonia, which can include multiorgan dysfunction 2
Clinical Recognition and Management
When to Suspect This Complication
Consider pneumonia-induced ileus when a child presents with:
- Acute abdominal pain with distension and decreased bowel sounds 1
- Respiratory symptoms including cough, tachypnea (>50 breaths/min in infants 2-11 months, >40 breaths/min in children 1-5 years) 3
- Signs of respiratory distress: chest wall indrawing, nasal flaring, or grunting 3
- Fever with bilateral infiltrates on chest imaging 4
Diagnostic Approach
- Chest radiography is essential to identify bilateral pneumonia when abdominal symptoms are prominent 1
- Avoid unnecessary surgical exploration, as the likelihood of concurrent acute appendicitis with pneumonia is small 1
- Operative intervention should only be undertaken after careful and intensive investigation to rule out pneumonia as the primary cause 1
Treatment Strategy
- Initiate appropriate antibiotic therapy immediately based on age and severity 4, 5
- For children with bilateral pneumonia and systemic complications, hospitalization is mandatory 4, 3
- The ileus typically resolves with treatment of the underlying pneumonia 1
- Amoxicillin 90 mg/kg/day divided into 2 doses is first-line for community-acquired pneumonia in children 5
Severity Assessment and Hospitalization
Children with bilateral pneumonia warrant hospitalization when they have:
- Hypoxemia (SpO2 <90% at sea level) 4, 3
- Moderate to severe respiratory distress 4, 3
- Age <3-6 months with suspected bacterial infection 4
- Toxic appearance: lethargy, inability to feed, persistent vomiting 3
Important Caveats
- While ileus can occur with pneumonia, always maintain clinical vigilance for true surgical abdominal emergencies 1
- Bilateral pneumonia is more severe than unilateral disease and may indicate tuberculosis, parasitic infection, or highly virulent pathogens 4
- The presence of complicated pneumonia (empyema, necrotizing pneumonia) increases risk of systemic complications including potential gastrointestinal involvement 2
- Streptococcus pneumoniae and Staphylococcus aureus are common causative organisms in complicated pneumonia 2