Abdominal Distention and Emesis in a Term Neonate |
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| Affiliation: | 1. Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina;2. Department of Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina;1. Florida Atlantic University, College of Medicine, 777 Glades Road, Boca Raton, FL, 33431, USA;2. Office of Human Research, Memorial Healthcare System, 4411 Sheridan Street, Hollywood, FL, 33021, USA;3. Division of Pediatric Neurosurgery, Joe DiMaggio Children’s Hospital, 1150 N 35th Ave., Hollywood, FL, 33021, USA;4. Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA;1. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas;2. Department of Oncology, Zhong Shan Hospital, Xiamen Medical University, Xiamen, People’s Republic of China;3. Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China;4. Department of Emergency Medicine, King Hussein Cancer Center, Amman, Jordan;5. Department of Intensive Care, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China;7. Center of Diagnosis and Treatment of Cervical Disease, Obstetrics and Gynecology Hospital of Fudan University, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, People’s Republic of China;11. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas;12. Department of Laboratory Medicine, Qilu Hospital, Qilu Medical University, Jinan, Shandong, People’s Republic of China;8. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas;10. Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas;1. Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada;2. Poison and Drug Information Service, Alberta Health Services, Calgary, Alberta, Canada;3. Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada;4. Department of Emergency Medicine, Queen''s University, Kingston, Ontario, Canada;5. Section of Clinical Pharmacology and Toxicology, Alberta Health Services, Calgary, Alberta, Canada;7. Rocky Mountain Poison and Drug Safety, Denver Health, Denver, Colorado |
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| Abstract: | BackgroundNecrotizing enterocolitis (NEC) is a gastrointestinal emergency characterized by ischemic necrosis of the intestinal mucosa, leading to bacterial translocation and pneumatosis of the bowel wall. Although there are numerous studies on clinical presentations of preterm NEC, approximately 10–15% of cases occur in full-term neonates. Nearly 10% of all infants with NEC will develop a rapidly progressive and fatal form of the disease called NEC totalis.Case ReportA 24-day-old term male infant presented to the Emergency Department (ED) with emesis. The infant was ill-appearing with a tense abdomen and had significant tachycardia and hypotension. The patient was immediately volume resuscitated and started on empiric antibiotics. Initial radiographs revealed no evidence of bowel obstruction or pneumatosis. Pediatric Surgery was consulted, and upper gastrointestinal and abdominal computed tomography scans were obtained, which were nondiagnostic. The patient was taken to the operating room for an exploratory laparotomy after continued clinical deterioration and was diagnosed with NEC totalis and passed away within 6 days.Why Should an Emergency Physician Be Aware of This?This case demonstrates an uncommon presentation of NEC in an otherwise healthy term neonate without any known risk factors. The diagnosis of NEC is challenging because imaging studies may be inconclusive, particularly early in the clinical course. Regardless of the etiology, all infants who present to the ED with signs and symptoms of severe gastrointestinal distress should be treated with basic emergency care, including rapid fluid resuscitation, empiric antibiotics, bowel decompression, and early surgical consultation. |
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| Keywords: | necrotizing enterocolitis term emergency sepsis abdominal |
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