Necrotizing enterocolitis is typically seen in premature infants, and the
time of its onset is generally inversely proportional to the gestational age of
the baby at birth. Clinical symptoms found in cases of necrotizing enterocolitis
are feeding intolerance, increased, abdominal distension and bloody stools.
Complications can be intestinal perforation and peritonitis. The most common
area of the bowel affected by necrotizing enterocolitis is near the ileocecal
The cause of the disease is unknown
The diagnosis is usually suspected clinically but often
requires the aid of diagnostic imaging modalities such as plain x ray films of
the abdomen and or ultrasound. to confirm the diagnosis and to evaluate the
severity of the disease. Initial radiological signs of necrotizing enterocolitis
are dilated bowel loops or a "fixed loop" (unaltered gas-filled loop of bowel).
The most pathognomonic X ray finding in necrotizing enterocolitis is pneumatosis
intestinalis. Other findings include portal venous gas and pneumoperitoneum
Ultrasound can be very useful because it can detect signs and complications
of necrotizing enterocolitis before they are evident on x ray films. Especially
air in the bowel wall and portal venous gas can be picked up by ultrasound in a
very early stage. Free peritoneal fluid although non specific is seen easily
In patients suspected of having a necrotizing enterocolitis, or when there is
evidence of a necrotizing enterocolitis, frequent monitoring is indicated to
detect complications in an early stage. This is usually done with plain X ray
films. Since ultrasound can pick up signs of complication in an early stage, when it is available can be added to the monitoring
Treatment consists primarily of supportive medical care. When the disease
does not respond to medical treatment alone, or when the bowel perforates,
surgery to resect the dead bowel is generally required.
The prognosis of patients that can be treated conservatively is usually good.
The prognosis of patients that require surgery are less favorable. Late
complications include short bowel syndrome.
For more cases of bowel wall
pathology in children see www.ultrasoundcases.info