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Neonatal Med > Volume 21(3); 2014 > Article
Neonatal Medicine 2014;21(3):192-197.
DOI: https://doi.org/10.5385/nm.2014.21.3.192    Published online August 30, 2014.
Three Cases of Preterm Infants Showing Pneumatosis Intestinalis without Progression to Typical Necrotizing Enterocolitis.
Eui Kyung Choi, Hyerim Kim, Jung Yoon Choi, Suyeong Kim, Euiseok Jung, Juyoung Lee, Chang Won Choi, Beyong Il Kim
1Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea. choicw@snu.ac.kr
2Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.
Abstract
Necrotizing enterocolitis (NEC) is a major gastrointestinal disorder in premature infants associated with high morbidity and mortality rates. When NEC is clinically suspected, radiological and laboratory studies should be performed to confirm the diagnosis and to aid in the management of patients. As the clinical manifestations of NEC are usually nonspecific, diagnoses are often made using abdominal radiographic findings, such as pneumatosis intestinalis. Clinicians typically consider the presence of pneumatosis intestinalis on radiographs as the definite evidence of stage II NEC. Here, we report 3 cases of preterm infants who had radiographic findings of pneumatosis intestinalis but did not have any other associated laboratory and clinical evidence of NEC, except bloody stools. The infants' systemic manifestations were mild or absent, and all of them completely recovered within 2-3 days, as demonstrated by the resolution of pneumatosis intestinalis on abdominal radiographs. The combination of hematochezia and intestinal pneumatosis in preterm infants strongly suggests the diagnosis of NEC. In our cases, there was no laboratory evidence of inflammation or platelet consumption, and the clinical course was benign without any sings of surgical abdomen. Additionally, our patients had barium-induced colitis or milk protein allergy, which are other possible causes of pneumatosis intestinalis. Because pneumatosis intestinalis can result from causes other than NEC, it is important to consider clinical, laboratory, and radiological findings to confirm the diagnosis of NEC.
Key Words: Necrotizing enterocolitis, Pneumatosis intestinalis, Premature infant
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