Presentation
Abdominal distension. History of prematurity with two episodes of necrotizing enterocolitis.
Patient Data
X-rays taken at 22 and 23 days of age showing diffuse bowel dilatation. Multiple mottled lucencies, suspicious of pneumatosis intestinalis, are noted in the upper central abdomen on the 2nd radiograph. No pneumoperitoneum or portal venous gas is seen.
X-rays taken at 10 and 11 weeks of age showing multiple dilated bowel loops with no gas seen in the rectum. Linear lucencies in the peripheral bowel, suspicious for pneumatosis intestinalis, are noted in the right hypochondrium on the 1st radiograph. No pneumoperitoneum or portal venous gas is seen.
Multiple dilated gas-filled bowel loops in the upper central abdomen. Two persistent short-length focal strictures are seen in the ascending colon. The morphology of the remaining colon is within normal limits. Some contrast reflux is noted from the cecum into the dilated distal small bowel loops. No contrast extravasation or pneumoperitoneum is seen.
Histopathology report of the resected ascending colon specimen showing extensive mucosal ulceration and transparietal fibrosis.
Case Discussion
history of prematurity (born at 28 weeks gestation) with respiratory distress syndrome, two episodes of necrotizing enterocolitis (managed conservatively), and positive respiratory and blood cultures for Escherichia coli
the patient underwent exploratory laparotomy with resection of a segment of the ascending colon and anastomosis
bowel strictures, the most common complication in the late stage of NEC, are usually seen 4-8 weeks after NEC 1. More than 80% of these strictures are seen in the colon, with ascending colon being the most commonly affected site 1. Single-stage surgery (stricture resection and anastomosis) is the only effective treatment for post-NEC strictures 1
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