Comprehensive radiological diagnosis of necrotizing enterocolitis in newborns

Abstract

Background. Necrotic (necrotizing) enterocolitis (NEC) (P77) is a non-specific inflammatory disease caused by infectious agents against the background of immaturity of local defense mechanisms and/or hypoxic-ischemic damage to the intestinal mucosa prone to generalization with the development of systemic inflammatory response. The purpose of the study is to determine the X-ray and ultrasound symptoms of NEC in newborns depending on the stage of the disease. Materials and methods. X-ray and ultrasound data of the abdominal organs were analyzed in 32 newborns, of which 28 (87.5 %) were preterm, 4 (12.5 %) — full-term. Results. NEC stage 1 has been detected in 18.8 % of cases: hyperpneumatosis of the intestine — in 16.7 %, loops in the form of “staples”, thickening of the intestinal walls — in 83.3 %; small horizontal levels of liquid with gas over them — in 33.3 %. Ultrasound examination revealed thickening of the intestinal walls, decreased peristalsis in the affected segments. NEC stage 2 was diagnosed in 31.3 % of cases: rigid bowel loops — in 30 %; static bowel loops — in 40 %. During ultrasound examination, thickening of the intestinal walls was detected, as well as decreased peristalsis in the affected segments, and the presence of transparent effusion. Color flow mapping revealed an amplified or hyperemic type of blood flow in the intestinal wall. NEC stage 3 was diagnosed in 28.1 % of cases: pneumatosis of the gut wall — in 77.8 %; against the background of the shadow of the liver — air in the branches of the portal vein (33.3 %). Ultrasound examination revealed: signs of inflammation in the intestinal wall (77.8 %); pneumatosis of the bowel wall (88.9 %) and distribution of gas in the portal vein (44.4 %). In NEC stage 4 (21.9 %), pneumoperitoneum was detected. Conclusions. The main objective of the radiation study of children with NEC is the detection of the entire set of manifestations that allow diagnosing the disease as early as possible and determining the adequate treatment for the patient. Ultrasound examination should be performed for all patients, especially with nonspecific X-ray or questionable clinical signs of NEC.

Keywords

• necrotizing enterocolitis
• abdominal organs
• radio­graphy
• ultrasound examination
• newborns