Necrotizing enterocolitis

Case contributed by Rad_doc


25 week old is admitted to the NICU for supportive care. After 2 days she is noted to have increasing abdominal distention. Abdominal radiographs are ordered.

Patient Data

Age: 25 week old, day 2 of life
Gender: Female

Radiograph Series

Mildly dilated loops of bowel with pneumatosis intestinalis and portal venous gas. No free intraperitoneal air is identified. 


annotated images

  1. Magenta outline indicates area of pneumatosis intestinalis.
  2. Cyan area indicates portal venous gas outlining the portal veins. 

The patient is managed conservatively and is eventually transferred out the ICU. While on the general pediatrics floor, the patient becomes distended once again and is inconsolable. Repeat abdominal X-ray shows multiple distended loops of large and small bowel. 


Contrast does not flow past the sigmoid colon. This finding is highly concerning for colonic stricture.

Case Discussion

Necrotizing enterocolitis is a relatively common complication of prematurity. While most often managed medically, it is important to know the indications for surgery (such as free air). Despite therapy, many surviving patients can go on to develop colonic strictures as seen in this case. 

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Case information

rID: 47589
Published: 13th Sep 2016
Last edited: 14th Aug 2019
System: Paediatrics
Inclusion in quiz mode: Included