Aspectos radiológicos relevantes no diagnóstico da enterocolite necrosante e suas complicações

Abstract

A enterocolite necrosante representa uma das emergências gastrintestinais mais freqüentes e graves no período neonatal. Na suspeita clínica dessa doença, o exame radiológico simples de abdome é um procedimento de rotina, desempenhando um papel fundamental no diagnóstico, acompanhamento e detecção de complicações. No presente trabalho, realizamos uma revisão da literatura pertinente e descrevemos os achados radiológicos da enterocolite necrosante, ilustrados com casos do nosso serviço. Concluímos que o diagnóstico radiológico da enterocolite necrosante realizado em todas as suas etapas, contribui para uma conduta terapêutica imediata, reduzindo as complicações e aumentando a sobrevida dos pacientes.

Presence of air in the hepatic portal system in association with umbilical venous catheter malposition

“…The radiological finding of air in the portal system, as associated with necrotizing enterocolitis, is almost always followed by intestinal pneumatosis (6,7) . In the present case, there was no evidence of pneumatosis intestinalis at radiography, but as the presence of portal air in neonates is associated with a high risk for necrotizing enterocolitis, such a diagnostic suspicion should be raised and ruled out (5)(6)(7)(8) . Subsequent radiography demonstrated that the air had disappeared and clinical and laboratory findings did not confirm the necrotizing enterocolitis hypothesis.…”

Necrotizing Enterocolitis: Case Report with Bibliographic Review

“…Intestinal pneumatosis, defined as the presence of air in the intestinal wall, is characterized as a pathognomonic radiological signal of NEC. However, the most frequent radiological alteration in NEC is the generalized gastric distension of intestinal loops [17].…”

“…Aeroportia is a finding that corresponds to fine luscism of the hepatic portal region to the peripheral region of the liver and corresponds to a practically pathognomonic finding of NEC. Other findings that may be present are the presence of portal gas, which is transitory indicating the presence of air in the portal venous system and pneumoperitoneum, with good visibility in left lateral decubitus [17,18].…”

“…Studies show that more severe cases of NEC are related to findings in the USG of free peritoneal gas, focal collections of fluid or of three or more of the following: absence of bowel perfusion at Doppler, increased intestinal wall echogenicity, gas at the door, thickening of the intestinal wall (greater than 2.7 mm) intestinal wall thinning (less than 1 mm), free fluid with echoes and intramural gas. The USG was extremely useful in cases of non-specific and indeterminate clinical and radiological findings for NEC and in cases with a diagnostic definition of necrotising enterocolitis, but without good therapeutic response of the newborn [17,18,27].…”

“…Protective measures include administration of prenatal cortico-therapy enteral administration of probiotics in neonates with risk factors for NEC, use of enteral antibiotic therapy, administration of supervised parenteral diet, minimum enteral institution, enteral feeding with human milk, enteral administration of IgG and IgA immunoglobulins [1,2,9,[14][15][16][17]. abdominal distension, vomiting or gastric stasis, accompanied by radiological and laboratory signs in the most severe cases.…”