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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. 

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.
 
About the Author 
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