Necrotizing enterocolitis

Case contributed by Hani Makky Al Salam


Low birth weight and abdominal distention

Patient Data

Age: 12 days
Gender: Male

Moderate distention of the bowel loops.  Intramural air in the ascending colon is noted.  No free air could be seen. This is suggestive of NEC.

NG tube sideholes in the esophagus. This should be advanced.


The liver is normal in size with diffuse branching echogenic foci in keeping with portal venous air. There are echogenic foci within the bowel wall mainly in the right lower quadrant with absent flow, highly suggestive of pneumatosis intestinale.

Case Discussion

The x-ray demonstrates multiple dilated loops of bowel without convincing intraperitoneal or portal gas. Intramural gas can however been seen laterally in both flanks.

Ultrasound confirms not only intramural gas (echogenic bowel wall with dirty-shadowing) but also demonstrated portal venous gas as multiple, sometimes branching regions of echogenicity within the liver, again with shadowing. 

Features are consistent with necrotizing enterocolitis.

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