Abstract
Background
There is little in the literature regarding the use of gray-scale and Doppler sonography of the bowel in necrotizing enterocolitis (NEC) and how findings depicted by this modality might assist in predicting outcome and influence management.
Objective
To correlate sonographic findings with outcome in NEC.
Materials and methods
This was a retrospective analysis of clinical and abdominal ultrasonography (AUS) findings in NEC from January 2003 to December 2005. AUS findings were evaluated for portal venous gas, free gas, peritoneal fluid, bowel wall thickness, echogenicity, perfusion and intramural gas. Patients were categorized into two groups, according to their outcome.
Results
A total of 40 infants were identified who had AUS for NEC prior to any surgical intervention. Group A comprised 18 neonates treated medically and recovered fully, and group B comprised 22 neonates who required surgery or died. Free gas (six patients) and focal fluid collections (three patients) were only found in group B. Increased bowel wall echogenicity, absent bowel perfusion, portal venous gas, bowel wall thinning, bowel wall thickening, free fluid with echoes and intramural gas were seen in both groups, but more frequently in group B. Anechoic free fluid was seen more frequently in group A. Increased bowel perfusion was seen equally in both groups.
Conclusion
An adverse outcome was associated with the sonographic findings of free gas, focal fluid collections or three or more of the following: increased bowel wall echogenicity, absent bowel perfusion, portal venous gas, bowel wall thinning, bowel wall thickening, free fluid with echoes and intramural gas. Sonographic findings are useful in predicting outcome and therefore might help guide management.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-006-0393-x/MediaObjects/247_2006_393_Fig1_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-006-0393-x/MediaObjects/247_2006_393_Fig2_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-006-0393-x/MediaObjects/247_2006_393_Fig3_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-006-0393-x/MediaObjects/247_2006_393_Fig4_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-006-0393-x/MediaObjects/247_2006_393_Fig5_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-006-0393-x/MediaObjects/247_2006_393_Fig6_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-006-0393-x/MediaObjects/247_2006_393_Fig7_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00247-006-0393-x/MediaObjects/247_2006_393_Fig8_HTML.gif)
Similar content being viewed by others
References
Faingold R, Daneman A, Tomlinson G et al (2005) Necrotizing enterocolitis: assessment of bowel viability with color Doppler US. Radiology 235:587–594
Epelman M, Daneman A, Navarro OM et al (2007) Necrotizing enterocolitis (NEC): a review of state-of-the-art imaging findings with pathologic correlation. Radiographics (in press)
Kim WY, Kim WS, Kim IO et al (2005) Sonographic evaluation of neonates with early-stage necrotizing enterocolitis. Pediatr Radiol 35:1056–1061
Kohzaki S, Hayashi K, Fukuda T et al (1994) Case report: the “aurora sign” – a new sonographic sign of pneumatosis cystoides intestinalis. Br J Radiol 67:1275–1277
Goske MJ, Goldblum JR, Applegate KE et al (1999) The “circle sign”: a new sonographic sign of pneumatosis intestinalis – clinical, pathologic and experimental findings. Pediatr Radiol 29:530–535
Braccini G, Lamacchia M, Boraschi P et al (1996) Ultrasound versus plain film in the detection of pneumoperitoneum. Abdom Imaging 21:404–412
Seitz K, Reising KD (1982) Sonographic detection of free air in the abdominal cavity. Ultraschall Med 3:4–6
Rabinowitz JG, Siegle RL (1976) Changing clinical roentgenographic patterns of necrotizing enterocolitis. AJR 126:560–566
Miller SF, Seibert JJ, Kinder DL et al (1993) Use of ultrasound in detection of occult bowel perforation in neonates. J Ultrasound Med 12:531–535
Buonomo C (1999) The radiology of necrotizing enterocolitis. Radiol Clin North Am 37:1187–1198
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Silva, C.T., Daneman, A., Navarro, O.M. et al. Correlation of sonographic findings and outcome in necrotizing enterocolitis. Pediatr Radiol 37, 274–282 (2007). https://doi.org/10.1007/s00247-006-0393-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-006-0393-x