THE RADIOLOGY OF NECROTIZING ENTEROCOLITIS
Section snippets
RADIOLOGY
Once NEC is suspected, a regular routine of abdominal films is instituted. We obtain supine films of the abdomen every 12 to 24 hours depending on the clinical status of the baby. In more ill children, the supine film is accompanied by one obtained by a horizontal beam for detection of free air. Either a supine cross-table lateral view or a left-side-down decubitus view may be obtained. Both are extremely sensitive for the detection of free air (see later). The cross-table lateral is easier to
COMPLICATIONS
Babies who survive NEC, both those treated medically and surgically, may develop a number of late complications. Infants who have had extensive bowel resection may develop short-gut syndrome with its attendant complications. Survivors treated both medically and surgically may develop intestinal strictures. The babies with strictures may be asymptomatic but most develop signs and symptoms of bowel obstruction weeks to months after the initial diagnosis of NEC. About 10% to 20% of babies with NEC
FOCAL INTESTINAL PERFORATION WITHOUT NECROTIZING ENTEROCOLITIS
NEC is the most common cause of intestinal perforation in the newborn period. Other common causes include intestinal obstruction, idiopathic gastric perforation, and iatrogenic causes, such as malpositioned nasogastric tubes.16 In recent years, there have been many reports of neonates who have developed focal perforations of the intestine without evidence of NEC.2, 8, 15, 31, 33, 34, 38, 44, 47 Focal perforation without NEC, in fact, probably represents the second most common cause of
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Address reprint requests to Carlo Buonomo, MD, Department of Radiology, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
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Children's Hospital; and the Department of Radiology, Harvard Medical School, Boston, Massachusetts