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previously visited 2 MONTH OLD MALE WITH ABDOMINAL DISTENTION Random Case
Authored By: Faculty and residents Children's Hospital, Radiologist, Children's Health System, Birmingham, Alabama., USA.
Patient: 2 month 5 day old male
History: 2 month old premature infant with abdominal distention/pain
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Fig. 1
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Findings:

Right lower quadrant pneumatosis
Portal venous gas
Bowel wall edema
Distended bowel loops

Diagnosis: Necrotizing enterocolitis
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.

References: Pediatric Requisites (2nd Edition). Blickman, Hans.
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Additional Details:

Case Number: 1495547Last Updated: 12-07-2005
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Anatomy: Gastrointestinal (GI)   Pathology: Infection
Modality: Conventional RadiographAccess Level: Readable by all users
Keywords: necrotizing enterocolitisContained in: ahmeeed
Case has been viewed 1177 times.

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