Table of Contents  
LETTER TO THE EDITOR
Year : 2016  |  Volume : 9  |  Issue : 3  |  Page : 421-422  

Radiological features of necrotizing enterocolitis in a neonate


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 Publication17-May-2016

Correspondence Address:
Aakash Pandita
Department of Paediatrics, SMGS Hospital, Jammu, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.182533

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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

Sir,

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

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  1. 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) [1]
  2. 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 [2]
  3. Portal venous gas (PVG) had been thought to be a predictor of poor outcome and an indication for surgical intervention. [3]
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.

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. [4] There was no difference in survival rates between those patients with PVG and those without (17% vs. 20%). [4] 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. [5] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Devos AS, Blickman JG, Blickman JG. Radiological Imaging of the Digestive Tract in Infants and Children. Rotterdam, The Netherlands: Springer Verlag; 2007.  Back to cited text no. 1
    
2.
Kliegman RM, Hack M, Jones P, Fanaroff AA. Epidemiologic study of necrotizing enterocolitis among low-birth-weight infants. Absence of identifiable risk factors. J Pediatr 1982;100:440-4.  Back to cited text no. 2
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3.
Sharma R, Tepas JJ 3 rd , Hudak ML, Wludyka PS, Mollitt DL, Garrison RD, et al. Portal venous gas and surgical outcome of neonatal necrotizing enterocolitis. J Pediatr Surg 2005;40: 371-6.  Back to cited text no. 3
    
4.
Sharma R, Hudak ML, Tepas JJ 3 rd , Wludyka PS, Marvin WJ, Bradshaw JA, et al. Impact of gestational age on the clinical presentation and surgical outcome of necrotizing enterocolitis. J Perinatol 2006;26:342-7.  Back to cited text no. 4
    
5.
Bömelburg T, von Lengerke HJ. Sonographic findings in infants with suspected necrotizing enterocolitis. Eur J Radiol 1992;15:149-53.  Back to cited text no. 5
    


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