Necrotizing Enterocolitis

Case #001

Date: 11/5/2012



History

4 day old premature baby boy with grossly blood stools.

Images

Chen - 001 - Necrotizing enterocolitis image 1.jpg
Supine radiograph demonstrates pneumatosis intestinalis, but no pneumoperitoneum.

Fig. 1 - Supine radiograph demonstrates pneumatosis intestinalis,but no pneumoperitoneum.
Chen - 001 - Necrotizing enterocolitis image 2.jpg


Fig. 2 - Crosstable lateral radiograph is negative for free air.


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Follow up radiograph 2 days later shows no evidence of pneumatosis.

Fig 3. Surveillance radiographs show improving pneumatosis and 2 days later, there is no plain film evidence of pneumatosis.
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Abdominal ultrasound performed shortly after the radiograph in Fig 3 shows that foci of air are still present in the bowel wall.


Fig 4. Abdominal ultrasound performed shortly after the radiograph in Fig 3 shows that echogenic foci of air are still present in the bowel walls.




Diagnosis

Necrotizing Enterocolitis.

Explanation

Necrotizing enterocolitis (NEC) is typically seen in premature infants in the ICU setting. The classical clinical scenario is feeding tolerance, abdominal distention, and bloody stools in the first 1-2 weeks of life.

The etiology is idiopathic and likely a combination of ischemia and infection. Radiographic findings can include bowel dilatation, "featureless" bowel loops, bowel wall edema, and a static bowel gas pattern, but the most definitive finding is pneumatosis intestinalis. Ultrasound has been studied as an adjunct to conventional radiography for diagnosing and monitoring NEC.

Treatment includes abdominal decompression, bowel rest, intravenous antibiotics, and monitoring with serial radiographs for evidence of bowel perforation. The finding of pneumoperitoneum is considered a surgical emergency.

Resources

Donelly, Lane. Fundamentals of Pediatric Radiology. Philadelphia: Saunders, 2001.

Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011 Jan 20;364(3):255-64.
Silva CT, Daneman A, Navarro OM, et al. Correlation of sonographic findings and outcome in necrotizing enterocolitis. Pediatr Radiol. 2007 Mar;37(3):274-82.