Necrotizing enterocolitis

Case contributed by Rad_doc


Admission to the NICU for supportive care. After 2 days she is noted to have increasing abdominal distention. Abdominal radiographs are requested.

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 gas is identified. Tight windowing allows for easy visualization of pneumatosis and portal venous gas.

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 NICU. 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 gas). Despite therapy, many surviving patients can go on to develop colonic strictures as seen in this case.

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