Usefulness of ultrasound examinations in the diagnostics of necrotizing enterocolitis

Joanna Staryszak, Joanna Stopa, Iwona Kucharska-Miąsik, Magdalena Osuchowska, Wiesław Guz, Witold Błaż, Joanna Staryszak, Joanna Stopa, Iwona Kucharska-Miąsik, Magdalena Osuchowska, Wiesław Guz, Witold Błaż

Abstract

Background: Necrotizing enterocolitis (NEC) is one of the most serious disorders of gastrointestinal tract during neonatal period. Early diagnosis and adequate treatment are essential in the presence of clinical suspicion of NEC. Plain abdominal radiography is currently the modality of choice for initial evaluation of gastrointestinal tract in neonates. However, when the diagnosis is uncertain, abdominal ultrasound with bowel assessment might be an important complementary examination. The aim of the study was to evaluate usefulness of ultrasound in the diagnosis of NEC and its value for implementation of proper treatment.

Material/methods: The data of nine neonates diagnosed with NEC, hospitalized at the Provincial Hospital No. 2 in Rzeszow in the period from September 2009 to April 2013 was retrospectively analyzed. Apart from abdominal radiography, abdominal ultrasound with bowel assessment was performed in all nine cases. Imaging findings, epidemiological data, coexisting risk factors and disease course were assessed.

Results: Most children in the group were preterm neonates. Findings in plain abdominal radiography were normal or nonspecific. A wider spectrum of findings was demonstrated in all ultrasound examinations and intestinal pneumatosis, a pathognomonic sign for NEC, was more frequently noted than in plain abdominal x-ray. Most children were treated by surgical intervention with resection of necrotic bowel loops and in more than half of the cases location of changes identified during surgery was concordant with ultrasonographic findings.

Conclusions: Abdominal ultrasound examination might be helpful in the diagnosis of NEC, especially when plain abdominal radiography findings do not correlate with clinical symptoms. However, abdominal radiography is still considered the modality of choice. The range of morphological changes detectable on ultrasound examination is much wider than in plain abdominal radiography. Ultrasound examination allows for more accurate assessment of changes within intestines and adjacent tissues, which aids clinicians in making more accurate therapeutic decisions and implementing proper treatment.

Keywords: Diagnostic Imaging; Emergency Treatment; Neonatology.

Figures

Figure 1
Figure 1
Ultrasound image of intestinal pneumatosis of large intestine (arrows).
Figure 2
Figure 2
Plain x-ray performed in left lateral decubitus position: tiny air bubbles within intestinal wall (arrow).
Figure 3
Figure 3
Ultrasound image of portal venous gas (arrows).
Figure 4
Figure 4
Ultrasound image of subsplenic intraperitoneal free air (arrows).
Figure 5
Figure 5
Ultrasound image of thickened, hyperechogenic bowel wall (arrows).
Figure 6
Figure 6
Ultrasound image of echogenic subhepatic intraperitoneal free fluid (star).
Figure 7
Figure 7
Ultrasound image of tiny intraperitoneal calcifications (arrows).

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Source: PubMed

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