Neonatal Necrotizing Enterocolitis: Radiological Manifestations

The radiographic manifestations of necrotizing enterocolitis (NEC) were reviewed in 44 infants. As the clinical presentation of NEC could often not be distinguished from sepsis and/or surgical abdominal problems, abdominal X-ray is by far the most sensitive test for the presence of this disease. Nonspecific radiological findings which frequently accompanied or preceded the appearance of intramural gas include bowel distension, a foamy pattern and asymmetry of gas pattern. The presence of these findings is an indication to repeat radiological abdominal examinations as an adjunct in the early diagnosis of NEC. The radiological hallmark of NEC is intramural gas, though this may be absent in infants with fulminating disease. If pueumoperitoneum occurs, it is diagnosed almost always at the onset or within 24 hours of the disease. Portal venous gas may be a transient sign and is not as ominous as previously reported. Barium studies are not justified in the acute disease but the high incidence of intestinal stricture in survivors may warrant a contrast study during the recovery phase.