Fact-sheet: Necrotizing enterocolitis


Updated on 10/03/2018 at 9:05 AM

Note : 0/10
Share

View all RADEOS cases associated with this fact-sheet

Definition

Inflammation followed by ischemia with ulceration and necrosis of the bowel in the premature newborn, leading to bacterial translocation +/- bowel perforation.

High morbidity and life-threatening prognosis.

Frequency inversely proportional to gestational age / birth weight.

Clinical features

Nonspecific:

  • Vomiting
  • Abdominal distension
  • Absent bowel sounds
  • Rectal bleeding
  • Sepsis
  • Respiratory distress or even shock

Laboratory findings

- Metabolic acidosis

- Thrombocytopenia or even DIC

Radiography

Plain abdominal radiograph:

  • Reflex ileus with bowel distension
  • Bowel wall edema with thumbprinting sign
  • Bowel wall pneumatosis
  • Portal venous gas
  • Pneumoperitoneum and Rigler sign (double wall sign) if perforation

Ultrasound

  • Bowel wall thickening
  • Wall vascular abnormalities: hypervascularization (inflammatory phase)
  • Absence of vascularization (necrosis)
  • Bowel wall pneumatosis
  • Portal venous gas
  • Peritoneal effusion +/- echogenic debris (if perforation)

Differential diagnosis

- Enterocolitis in the full-term infant: Perinatal distress, Congenital heart disease, Hirschprung disease

- Spontaneous focal intestinal perforation

- Intestinal volvulus

- Reactive ileus (sepsis)