| Discussion: Necrotizing enterocolitis (NEC)usually occurs (85%) in premature babies with weight of <2500 g and <37 weeks gestation.
Presentation 3-4 days old with bloody diarrhea (25%) or abdominal distention. May also have lethargy, sepsis signs, vomiting.
Etiology likely multifactorial: PROM, Preeclampsia, diabetes, placement of umbilical arterial and venous catheters increase risk for NEC.
Pathophysiology: Bowel ischemia with breakdown of mucosal barrier and entrance of bacteria. Bowel wall air within interstitium can then enter portal venous circulation.
Most common location is distal ileum or ascending colon (RLQ). Strictures are often colonic (80%), occur in up to 1/3 of patients with NEC. Splenic flexure most common location of colonic strictures. Perforation usually within first 36 hours. Perforation requires surgical treatment. Otherwise, can usually be treated more conservatively with antibiotics and bowel rest.
Definitive findings:
Pneumatosis
Portal venous gas
Perforation (free air) (Left lateral decubitus view useful)
Contrasted enema of value 6-12 months after acute stage to evaluate for strictures.
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2 MONTH OLD MALE WITH ABDOMINAL DISTENTION
