Perforated necrotizing enterocolitis

Case contributed by Dr Jeremy Jones


Preterm (28/40) neonate with RDS. Abdominal distension. Not responding well to being handled.

Patient Data

Age: 4 days
Gender: Female

NG tube, bladder catheter and right femoral line - positions appropriate.

Widespread gas-filled loops of bowel. No mural, free or portal-venous gas.

Very similar bowel gas pattern, concerning for NEC as suspected clinically. Mottling on the right side. No free, mural or portal-venous gas.

There is now clear evidence of free gas within the abdomen and Rigler sign centrally. On the lateral decubitus film, the volume is free gas is clearly demonstrated.

Case Discussion

Appearances of necrotizing enterocolitis (NEC) with associated perforation. Perforation is important to recognize and report because it will result in the reorientation of treatment from medical (antibiotics and resting the bowel) to surgical.

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Case information

rID: 62793
Published: 29th Aug 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: NHS Lothian

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