Abstract
BACKGROUND: Pneumoperitoneum on radiological imaging is typical in intestinal perforation in necrotizing enterocolitis [NEC]. However, it is not seen in all cases and intestinal perforation is missed on occasions. We present a series of preterm infants with characteristic x-ray findings that on exploration revealed missed intestinal perforation.METHODS: Retrospective review of neonates with intra-operative diagnosis of intestinal perforation which was missed on x-ray abdomen over a period of 6 months is being presented here.RESULTS: Three neonates born at 24 (24-30) weeks of gestation were identified. PDA was noted in all 3 patients and they required ventilator and inotropic support. Feeds were commenced at 5 (2-7) days of life. All three patients were treated for NEC. Surgical opinion was sought in view of localized gas shadow in a fixed position seen on repeated x-rays in all three patients. All three patients had laparotomy and small bowel resection with ileostomy formation at a mean age of 26 (24-46) days. Intra-operatively, small bowel perforation and adjacent pseudocysts filled with air and intestinal contents were noted in all 3 patients. Post-operatively full feeds were established in all patients.CONCLUSION: In premature infants with NEC, intestinal perforation can be missed on occasions. Our patients interestingly, developed characteristic abdominal x-ray findings that in our experience should prompt for surgical intervention.
Highlights
Necrotizing enterocolitis (NEC) is a severe inflammatory process of the gastrointestinal tract in neonates and is associated with a significant morbidity and mortality
In premature infants with NEC, intestinal perforation can be missed on occasions
Our patients interestingly, developed characteristic abdominal x-ray findings that in our experience should prompt for surgical intervention
Summary
Necrotizing enterocolitis (NEC) is a severe inflammatory process of the gastrointestinal tract in neonates and is associated with a significant morbidity and mortality. In NEC, the extent of disease could be focal [Isolated], multifocal or pan-intestinal. In a retrospective study on 32 patients with NEC, isolated NEC was present in 8 (25%), multifocal NEC in 19 (59%) and pan intestinal NEC in 5 (16%) of the operated cases [1]. Operative findings and outcomes are presented and discussed in this article. Pneumoperitoneum on radiological imaging is typical in intestinal perforation in necrotizing enterocolitis [NEC]. It is not seen in all cases and intestinal perforation is missed on occasions. We present a series of preterm infants with characteristic x-ray findings that on exploration revealed missed intestinal perforation
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