Correlation of sonographic findings and outcome in necrotizing enterocolitis.
BACKGROUND
There is little in the literature regarding the use of gray-scale and Doppler sonography of the bowel in necrotizing enterocolitis (NEC) and how findings depicted by this modality might assist in predicting outcome and influence management.


OBJECTIVE
To correlate sonographic findings with outcome in NEC.


METHODS
This was a retrospective analysis of clinical and abdominal ultrasonography (AUS) findings in NEC from January 2003 to December 2005. AUS findings were evaluated for portal venous gas, free gas, peritoneal fluid, bowel wall thickness, echogenicity, perfusion and intramural gas. Patients were categorized into two groups, according to their outcome.


RESULTS
A total of 40 infants were identified who had AUS for NEC prior to any surgical intervention. Group A comprised 18 neonates treated medically and recovered fully, and group B comprised 22 neonates who required surgery or died. Free gas (six patients) and focal fluid collections (three patients) were only found in group B. Increased bowel wall echogenicity, absent bowel perfusion, portal venous gas, bowel wall thinning, bowel wall thickening, free fluid with echoes and intramural gas were seen in both groups, but more frequently in group B. Anechoic free fluid was seen more frequently in group A. Increased bowel perfusion was seen equally in both groups.


CONCLUSIONS
An adverse outcome was associated with the sonographic findings of free gas, focal fluid collections or three or more of the following: increased bowel wall echogenicity, absent bowel perfusion, portal venous gas, bowel wall thinning, bowel wall thickening, free fluid with echoes and intramural gas. Sonographic findings are useful in predicting outcome and therefore might help guide management.
Silva
Cicero T
CT
Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, Ontario, M5G1X8, Canada.
Daneman
Alan
A
Navarro
Oscar M
OM
Moore
Aideen M
AM
Moineddin
Rahim
R
Gerstle
J Ted
JT
Mittal
Ashok
A
Brindle
Mary
M
Epelman
Monica
M
D001202:Ascitic Fluid / Q000000981:diagnostic imaging; D001724:Birth Weight; D020345:Enterocolitis, Necrotizing / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D005544:Forecasting; D005740:Gases; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging; D007416:Intestinal Perforation / Q000000981:diagnostic imaging; D007422:Intestines / Q000098:blood supply; D011169:Portal Vein / Q000000981:diagnostic imaging; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D005740:Gases