Atypical presentation of acute fulminant neonatal necrotising enterocolitis: diagnostic superiority of sonographic evaluation over plain radiography of abdomen.
A female preterm infant was born to a non-consanguineous couple at 35 weeks of gestation. On day 8 of life, while on full feeds, she developed prolonged apnoea and bradycardia, requiring respiratory support. Her abdomen was soft with unremarkable serial abdominal X-rays. Her septic screen was negative. Metabolic acidosis was worsening despite treatment. Echocardiography showed evidence of high pulmonary pressures. With further deterioration, an ultrasound scan of the abdomen was requested in view of the rising suspicion of abdominal pathology in the absence of sepsis and metabolic disorders. Mural oedema, pneumatosis and portal venous gas, consistent with diagnosis of necrotising enterocolitis, were noted in the ultrasound images. An emergency laparotomy showed extensive small bowel necrosis. Despite maximal medical support, the infant died. This case highlights the importance of imaging using an ultrasound scanner in the diagnosis of necrotising enterocolitis in preterm infants having intractable metabolic acidosis, subtle abdominal signs and unremarkable abdominal X-rays.
Department of Neonatology, KK Women's and Children's Hospital, Singapore.
Vidya
V
Ramasamy
Department of Diagnostic and Interventional imaging, KK Hospital, Singapore Duke-NUS Medical School, Singapore Yong Loo Lin School of Medicine, Singapore.
Harvey
H
Teo
Department of Neonatology, KK Women's and Children's Hospital, Singapore Duke-NUS Medical School, Singapore Yong Loo Lin School of Medicine, Singapore Lee Kong Chian School of Medicine, Singapore.
Victor Samuel
VS
Rajadurai
Department of Neonatology, KK Women's and Children's Hospital, Singapore Duke-NUS Medical School, Singapore Yong Loo Lin School of Medicine, Singapore Lee Kong Chian School of Medicine, Singapore.
Suresh
S
Chandran
Pediatr Radiol. 2007 Mar;37(3):274-82
17225155
Eur J Pediatr Surg. 2011 Jan;21(1):12-7
20954109
Pediatr Surg Int. 2011 Mar;27(3):321-7
20938666
Pediatr Radiol. 2005 Nov;35(11):1056-61
16078076
J Ultrasound Med. 1993 Sep;12(9):531-5
8107185
Pediatr Radiol. 2013 Nov;43(11):1444-52
23771727
Radiographics. 2007 Mar-Apr;27(2):285-305
17374854
Pol J Radiol. 2015 Jan 01;80:1-9
25574248
Ann Acad Med Singapore. 2013 Jul;42(7):328-37
23949262
Arch Dis Child Fetal Neonatal Ed. 2009 May;94(3):F183-7
18786962
Arch Dis Child Fetal Neonatal Ed. 2013 Sep;98(5):F445-50
23572342
Pediatr Surg Int. 2014 Dec;30(12):1231-40
25327619