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| Case
of the Month |
by Dr
Noreen Norfaraheen Lee Abdullah
MD (UKM),
MMed Radiology (UKM), AM(Mal)
Answer to Case Of the Month
Necrotising Enterocolitis (NEC)
Discussion of Findings
There is free air in the abdomen. Intramural
air is also present in the right iliac fossa. Slight dilatation of the small
bowel loops was also noted. The features favour necrotising enterocolitis.
The patient passed away from NEC at Day 7 of life.
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Pneumoperitoneum |
Pneumoperitoneum denotes
free air in the peritoneal cavity. Air enters the peritoneal cavity due to
an abnormal communication between an air containing space with the
peritoneal cavity. In neonates, the usual cause is due to perforation of the
gastrointestinal tract.
Differential diagnoses include:
- Necrotising
enterocolitis (NEC)
- Distal bowel
obstruction due to Imperforate anus, Hirschprung disease, Meconium ileus
- Iatrogenic causes -
Colon perforation due to thermometer or Enema
- Post laparotomy
- Paracentesis
- Resuscitation
Radiological findings in
NEC include small bowel dilatation in the initial phase. This finding is not
specific. Repeat AP supine radiographs are performed every 8 hours or
depending on the clinical situation in suspected cases. Deterioration
manifests at 48 hours usually. Specific signs are pneumatosis intestinalis
ie. gas within the bowel wall. Intramural gas when subserosal produces a
curvilinear sign. When submucosal, it produces a bubbly or cystic
appearance. Portal vein gas is occasionally seen. There are fine branching
lucencies extending from the porta hepatis to the periphery of the liver.
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| About
the Author |
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Dr Noreen, a Consultant
Radiologist is currently with the Universiti Sains Malaysia, Kubang Kerian,
Kelantan, Malaysia.
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Last Updated:
Tuesday, 04 January 2005 |
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