Presentation
Preterm newborn (33 weeks) with birth weight 2070 grams.
Patient Data
Multiple branching, air-containing venous structures extending to the periphery of the liver indicating air in the portal venous system.
Linear bands of radiolucency which parallel the wall of the bowel indicating the presence of pneumatosis intestinalis
A few dilated loops of bowel seen. No pneumoperitoneum
Case Discussion
Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in premature neonates, especially those of very low weight. It usually develops 2-3 days following birth, with 90% developing within the first 10 days of life. Early diagnosis, which relies on imaging findings, and prompt therapy are essential to limit morbidity and mortality.
The presentations are varied and may be nonspecific. Abdominal distension, vomiting, diarrhea, or blood per rectum occurs in association with systemic signs including fever, apnea, metabolic acidosis.
Plain abdominal radiography is the current modality of choice for the evaluation of neonates suspected of having NEC. Findings including dilated bowel loops, bowel wall edema with thumbprinting, pneumatosis intestinalis, portal venous gas, and pneumoperitoneum which indicates severe disease.
This patient was preterm (33 weeks) and birth weight was 2070 g. Presented with loose motion and metabolic acidosis. Abdominal x-ray showed thickened, dilated bowel loops, air in the portal venous system, pneumatosis intestinalis. No pneumoperitoneum.