Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 38

Clinical History:
The patient was a former 27 week premature female, now 18 days old. In the last 8 hours the patient underwent rapid clinical deterioration, developing abdominal distension and going from a non ventilated state to requiring high frequency ventilation. Ventilation was very difficult, secondary to the abdominal distension.

Clinical Physical Exam:
Distended abdomen

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Necrotizing enterocolitis

Imaging Findings:
Outside abdominal films from day of admission (not available) showed portal venous gas and pneumatosis intestinalis. No free air was seen.

Imaging Differential Diagnosis:
Necrotizing enterocolitis

Operative Findings:
The patient was taken emergently to the operating room for an exploratory laparotomy through a transverse umbilical incision. Cloudy fluid was encountered. The bowel was noted to be white and necrotic throughout its entire length from the duodenum to the colon. Total necrosis of the intestines was seen, secondary to necrotizing enterocolitis. There was no salvageable bowel. The abdomen was closed.

Image 1

Pathological Findings:
None

Final Diagnosis:
Necrotizing Enterocolitis

Follow-up and Prognosis:
The patient expired one day post operatively.

Similar Cases:
None

References:

• Paediapedia
• WebPath
• Cornell University Pediatric Pathology

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