|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 3 | Page : 421-422
Radiological features of necrotizing enterocolitis in a neonate
Aakash Pandita1, Monika Yachha2, Deepak Sharma3, Smita Pawar4, Mir Tariq5
1 Department of Paediatrics, SMGS Hospital, Jammu, Jammu and Kashmir, India
2 SGPGI Lucknow, U.P, India
3 Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana, India
4 Department of Obstetrics and Gynaecology, Fernandez Hospital, Hyderabad, Telangana, India
5 GMC Jammu, Jammu and Kashmir, India
|Date of Web Publication||17-May-2016|
Department of Paediatrics, SMGS Hospital, Jammu, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pandita A, Yachha M, Sharma D, Pawar S, Tariq M. Radiological features of necrotizing enterocolitis in a neonate. Med J DY Patil Univ 2016;9:421-2
|How to cite this URL:|
Pandita A, Yachha M, Sharma D, Pawar S, Tariq M. Radiological features of necrotizing enterocolitis in a neonate. Med J DY Patil Univ [serial online] 2016 [cited 2022 Dec 2];9:421-2. Available from: https://www.mjdrdypu.org/text.asp?2016/9/3/421/182533
A 28-week of 1 kg male neonate exclusively breastfed, presented with abdominal distention, shock, and thrombocytopenia on day 25 of postnatal life. On examination, the abdomen was distended, and the overlying skin was tense and shiny. Furthermore, there were altered aspirates and abdomen was tender. On general physical examination, there was tachycardia, tachypnea, and respiratory distress. He was kept nil per oral. Infant was started on intravenous fluids, antibiotics, and one unit of fresh frozen plasma was given, abdominal X-ray was done and following features were noted:
Diagnosis [Figure 1]:
|Figure 1: Typical necrotizing enterocolitis features in a neonate. Dilated bowel loops. Single arrow-pnematosis intestinalis double arrow-portal vein gas|
Click here to view
As per the history, physical examination of per abdomen tender mass and X-ray features, a diagnosis of NEC was made. Despite the best possible supportive care, the child succumbed to death on day 30 of postnatal life.
- An abnormal gas pattern with dilated loops of bowel that is consistent with ileus, and is typically seen in the early stages of the necrotizing enterocolitis (NEC) 
- Pneumatosis intestinalis, the hallmark of NEC, appears as bubbles of gas in the small bowel wall, and is seen in most patients with stages II and III NEC 
- Portal venous gas (PVG) had been thought to be a predictor of poor outcome and an indication for surgical intervention. 
PVG had been thought to be a predictor of poor outcome and an indication for surgical intervention. However, subsequent data do not support these assumptions. This was illustrated in a prospective study of 194 infants with NEC treated at a single center from 1991 to 2003.  There was no difference in survival rates between those patients with PVG and those without (17% vs. 20%).  Of the infants with PVG, those who were treated medically had a higher survival rate than those treated surgically (91% vs. 74%).
Radiological findings may vary by gestational age. This was illustrated in one observational series of 202 infants with NEC.  Although intramural gas was detected in all infants ≥37 weeks gestation with NEC, it was only present in 29% of those ≤26 weeks gestation. In addition, PVG was more common in infants ≥37 weeks when compared with those ≤26 weeks gestation (47% vs. 10%). Thus, the abdominal radiography may not be as helpful in the most immature infants. Particularly in these infants, treatment decisions should be based on the clinical suspicion as confirmatory radiographic findings may not be present.
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Conflicts of interest
There are no conflicts of interest.
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