{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:44:34Z","timestamp":1792133074181,"version":"4.4.0"},"reference-count":11,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Necrotizing enterocolitis (NEC) is predominantly a disease of premature infants and is rarely in older children. In immunocompromised patients, however, infectious enteritis may present with clinical and radiological findings resembling NEC. In this article, we present a pediatric liver transplant recipient who developed astrovirus\u2010induced gastroenteritis, pneumatous intestinalis, and portal venous gas and was successfully treated without surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report<\/jats:title>\n                    <jats:p>\n                      A 24\u2010month\u2010old girl presented with hematochezia 4\u2009months after liver transplantation for hepatoblastoma while receiving tacrolimus, mycophenolate mofetil, and corticosteroid therapy. She had a recent history of diarrhea followed by abdominal distention and lower gastrointestinal bleeding. Imaging studies demonstrated pneumatosis intestinalis and portal venous gas. Blood and stool cultures,\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Clostridium difficile<\/jats:italic>\n                      <\/jats:styled-content>\n                      antigen testing, and respiratory pathogen panels were negative, whereas stool PCR identified astrovirus. Based on the clinical presentation and imaging findings, Bell stage II NEC was diagnosed. The patient was managed conservatively with bowel rest, total parenteral nutrition, broad\u2010spectrum antimicrobial therapy, and temporary adjustment of immunosuppressive treatment. Her bleeding resolved within 48\u2009h, serial imaging showed regression of pneumatosis intestinalis, and she was discharged after 14\u2009days with complete clinical recovery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Astrovirus infection should be considered among the potential causes of NEC\u2010like gastrointestinal manifestations in pediatric liver transplant recipients. Although pneumatosis intestinalis and portal venous gas often due to intestinal ischemia, clinically stable transplant recipients may recover with careful monitoring and individualized conservative treatment, avoiding unnecessary surgical intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70496","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T05:48:02Z","timestamp":1792129682000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Astrovirus Gastroenteritis Mimicking Necrotizing Enterocolitis in a Pediatric Liver Transplant Recipient: A Case Report and Successful Conservative Management"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9478-1463","authenticated-orcid":false,"given":"K\u00fcbra","family":"Arslan","sequence":"first","affiliation":[{"name":"Department of Pediatric Gastroenterology Ankara University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9176-9100","authenticated-orcid":false,"given":"Arzu Meltem","family":"Demir","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology Ankara University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9679-0884","authenticated-orcid":false,"given":"\u0130lkin Elif G\u00fcnel","family":"Karaburun","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology Ankara University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3551-7267","authenticated-orcid":false,"given":"Ceyda Tuna","family":"K\u0131rsa\u00e7l\u0131o\u011flu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology Ankara University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0180-0013","authenticated-orcid":false,"given":"\u00d6mer Suat","family":"Fitoz","sequence":"additional","affiliation":[{"name":"Department of Radiology Ankara University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7726-7633","authenticated-orcid":false,"given":"Meltem Bing\u00f6l","family":"Kolo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Ankara University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3133-9846","authenticated-orcid":false,"given":"Aydan","family":"Kansu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology Ankara University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9442-7790","authenticated-orcid":false,"given":"Zarife","family":"Kulo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology Ankara University Faculty of Medicine  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s00383-023-05619-3","article-title":"Necrotizing Enterocolitis: Current Understanding of the Prevention and Management","volume":"40","author":"Hu X.","year":"2024","journal-title":"Pediatric Surgery International"},{"key":"e_1_2_9_3_1","volume-title":"StatPearls","author":"Ginglen J. G.","year":"2025"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"11937","DOI":"10.1128\/JVI.00942-07","article-title":"Astrovirus Increases Epithelial Barrier Permeability Independently of Viral Replication","volume":"81","author":"Moser L. A.","year":"2007","journal-title":"Journal of Virology"},{"issue":"2","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","DOI":"10.1111\/tid.14257","article-title":"Underrecognized Cause Diarrhea in Solid Organ Transplant: A Report of Astroviridae Enteritis in Liver Transplant","volume":"26","author":"Wilson P.","year":"2024","journal-title":"Transplant Infectious Disease"},{"issue":"12","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.29286","article-title":"Astrovirus VA1\/HMO Encephalitis After Allogeneic Hematopoietic Cell Transplantation: Significant Role of Immune Competence in Virus Control","volume":"68","author":"Kr\u00f3l L.","year":"2021","journal-title":"Pediatric Blood & Cancer"},{"issue":"8","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.ppat.1011544","article-title":"Pathogenesis and Outcome of VA1 Astrovirus Infection in the Human Brain Are Defined by Disruption of Neural Functions and Imbalanced Host Immune Responses","volume":"19","author":"Maximova O. A.","year":"2023","journal-title":"PLoS Pathogens"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/j.transproceed.2020.01.010","article-title":"Conservative Management of Pneumatosis Intestinalis and Portal Venous Gas After Pediatric Liver Transplantation","volume":"52","author":"Ryan J. L.","year":"2020","journal-title":"Transplantation Proceedings"},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"390","DOI":"10.6002\/ect.2020.0287","article-title":"Necrotizing Enterocolitis Following Pediatric Living Donor Liver Transplant","volume":"19","author":"Ramavath K.","year":"2021","journal-title":"Experimental and Clinical Transplantation"},{"key":"e_1_2_9_10_1","volume-title":"StatPearls","author":"Im J.","year":"2024"},{"key":"e_1_2_9_11_1","doi-asserted-by":"crossref","DOI":"10.1097\/MPG.0000000000000388","article-title":"Pneumatosis Intestinalis and Portal Venous Gas in Pediatric Liver Transplant Recipient","volume":"62","author":"Varma S.","year":"2016","journal-title":"Journal of Pediatric Gastroenterology and Nutrition"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"1984","DOI":"10.21037\/jtd.2018.02.52","article-title":"Pneumatosis Intestinalis in Solid Organ Transplant Recipients","volume":"10","author":"Gemma V.","year":"2018","journal-title":"Journal of Thoracic Disease"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70496","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/petr.70496","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70496","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T05:48:04Z","timestamp":1792129684000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70496"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":11,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/petr.70496"],"URL":"https:\/\/doi.org\/10.1111\/petr.70496","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-07-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70496"}}