Portal venous gas and surgical outcome of neonatal necrotizing enterocolitis

Sharma, Rajesh; Tepas, Joseph J.; Hudak, Mark L.; Wludyka, Peter; Mollitt, Daniel L.; Garrison, Robert D.; Bradshaw, James A.; Sharma, Monica

doi:10.1016/j.jpedsurg.2004.10.022

Cited by 75 publications

(75 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Not always intramural gas and gas in the portal system are associated with the disease severity. Also, not always the disappearance of these symptoms means a clinical recovery (19) . There is no review article demonstrating radiographic findings in patients with symptoms suggesting necrotizing enterocolitis and its association with their prognosis.…”

Section: Discussionmentioning

confidence: 99%

Valor preditivo da distensão de alças intestinais em radiografias no prognóstico de enterocolite necrosante

et al. 2007

View full text Add to dashboard Cite

OBJECTIVE: To evaluate the prognostic value of bowel loops dilatation as a finding on radiographs in the development and mortality of neonates with necrotizing enterocolitis. MATERIALS AND METHODS: On abdominal radiographs of 53 patients for diagnostic suspicion of necrotizing enterocolitis, the major diameters of dilated bowel loops (AD) were measured, as well as the distance between the upper border of the first lumbar vertebra and the lower border of the second one (L1-L2), and the distance between the lateral borders of the first lumbar vertebra (L1) pedicles, and the subsequent association between AD/L1-L2, AD/ L1. This measure was considered as a possible determining factor for potential complications, surgical intervention and mortality. RESULTS: The patients who needed surgical management and who had complications during progression and died of the disease had showed increased AD and AD/L1-L2 (p < 0.05). AD/ L1 values and site of the most dilated bowel loop were not different in the groups with unfavorable progression. CONCLUSION: Bowel loop dilatation detected on initial supine abdominal radiographs suggests a worst prognosis in necrotizing enterocolitis. Furthermore, measurement of the most dilated bowel loop on these radiographs is a simple and reproducible method that adds diagnostic and prognostic information. Keywords: Necrotizing enterocolitis; Radiography; Progression.Valor preditivo da distensão de alças intestinais em radiografias no prognóstico de enterocolite necrosante. OBJETIVO: Avaliar o valor prognóstico da distensão de alças intestinais observada em radiografias na evolução e mortalidade de neonatos com enterocolite necrosante. MATERIAIS E MÉTODOS: Nas radiografias de abdome de 53 pacientes obtidas no momento da suspeita diagnóstica de enterocolite necrosante, foi realizada a medida do diâmetro da alça mais distendida (AD), assim como a distância entre a borda superior da primeira vértebra lombar e a borda inferior da segunda (L1-L2), a distância entre as bordas laterais dos pedículos da primeira vértebra lombar (L1), e foram estabelecidas as associações entre AD/L1-L2 e AD/L1. Esta medida foi considerada como possível determinante de potenciais complicações, intervenção cirúrgica e mortalidade. RESULTADOS: Os pacientes que necessitaram de tratamento cirúrgico, aqueles que tiveram complicações durante a evolução e aqueles que morreram da doença tiveram a relação entre AD e AD/L1-L2 maiores (p < 0,05). Os valores de AD/L1 e a localização da alça mais distendida não foram diferentes nos grupos com evolução desfavorável. CONCLUSÃO: Distensão de alça intestinal detectada em radiografias de abdome realizadas na admissão sugerem pior prognóstico em enterocolite necrosante. Outrossim, medidas do diâmetro da alça mais distendida nessas radiografias são um método simples e reprodutível que oferece informações diagnósticas e prognósticas. Unitermos: Enterocolite necrosante; Radiografia; Evolução. AbstractResumo

show abstract

Section: Discussionmentioning

confidence: 99%

Valor preditivo da distensão de alças intestinais em radiografias no prognóstico de enterocolite necrosante

et al. 2007

View full text Add to dashboard Cite

show abstract

“…9,28,29 Extremely premature infants also seem less likely to present with PVG, possibly explained by lack of substrate in unfed or cautiously fed infants, reduced peristalsis in the immature gut, shortening of the phase of intramural bacterial growth in fulminant NEC, and lack of circulation in necrotic bowel. 23,24 Laboratory parameters include elevated C -reactive protein (CRP), 16 neutropenia, leucocytosis, thrombocytopenia, hyponatraemia, acidosis and hyperglycaemia 14 , which may be present in various combinations. The acidosis is commonly of mixed metabolic type 7 , but respiratory acidosis may occur in advanced disease 14. It is generally accepted that NEC should be differentiated from SIP, which, although often misdiagnosed as perforated NEC, is recognized as an entity of its own.…”

Section: Pathophysiologymentioning

confidence: 99%

“…52,53 In the 1980's and 90's PVG on US was described as an early sign of NEC, 44,54,55 as opposed to on AR, where it is considered a sign of advanced disease. 23,[56][57][58][59] Later studies, however, have not always been able to confirm the high sensitivity. 24,60,61 The specificity of most sonographic findings, i.e.…”

Section: Pathophysiologymentioning

confidence: 99%

“…The selection of articles may, however, not be complete. 40 1976 X Daneman 22 1978 X X X X X X Kogutt 41 1979 X Mata 48 1980 X X X Leonard 73 1982 X *Cikrit 74 1985 X Frey 75 1987 X X *Kennedy 76 1987 X Kosloske 56 1988 X X X Brill 77 1990 X Bömelburg 78 1992 X X X Rehan 43 1999 X X X X X X Molik 57 2001 X Tam 31 2002 X X X Faingold 70 2005 X Kim 60 2005 X Sharma 23 2005 X X X Coursey 50 2009 X X X X X X X Dördelman 24 2009 X X Bonhorst 34 2011 X Dilli 61 2011 X X X X Muchantef 53 2013 X X X X X X Silva 72 2013 X X X X Muller 79 2014 X * Abstracts only accessed US has been suggested to be used for: detection of PI, PVG, and intra-abdominal fluid and evaluation of bowel peristalsis, thickness, and perfusion of the bowel wall in neonates with mild symptoms and nonspecific plain film findings;…”

Section: Pathophysiologymentioning

confidence: 99%

See 1 more Smart Citation

Necrotising Enterocolitis - epidemiology and imaging

Ahle¹

View full text Add to dashboard Cite

“…A new pathogenetic hypothesis instead explains the NEC as a result of a series of imbalances caused by the immaturity of the gastrointestinal system, digestive system, circulatory regulation and of the immune system of the newborn. Intestinal immaturity leads to a compromised intestinal epithelial barrier, an underdeveloped immune defense, and altered vascular development and tone, so the newborn is more exposed to intestinal inflammation and sepsis (19,20).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic imaging features of necrotizing enterocolitis: a narrative review

Esposito¹,

Mamone²,

Serafino³

et al. 2017

Quant. Imaging Med. Surg.

View full text Add to dashboard Cite

Necrotizing enterocolitis (NEC) is an inflammatory process, characterized by intestinal necrosis of variable extension, leading to perforation, generalized peritonitis and death. The classical pathogenetic theory focuses on mucosal damage related to a stress induced intestinal ischemia leading to mucosal injury and bacterial colonization of the wall. A more recent hypothesis emphasizes the role of immaturity of gastrointestinal and immune system, particularly of the premature, responsible of bowel wall vulnerability and suffering. NEC is the most common gastrointestinal emergency in the newborn, with a higher incidence in the preterm; improvement of neonatal resuscitation techniques enables the survival of premature of very low birth weight (VLBW) with prolongation of hospital stay for perinatal and neonatal care and a higher risk of NEC. Clinical presentation of NEC in newborn ranges from mild forms with moderate gastrointestinal tract disorder and that can heal spontaneously, to very serious forms with fulminant course characterized by perforation, peritonitis, sepsis, disseminated intravascular coagulation (DIC) and shock. Imaging modality in the diagnosis of NEC is historically represented by the plain-film abdominal radiographs which can be performed every 6 hours because of the rapid evolution that may occur in the patient's clinical condition.However ultrasound (US), in recent years, is playing an increasingly important role in the evaluation of early stages of the disease as it provides images in real time of the abdominal structures being able to assess the presence and validity of peristalsis of the bowel loops, detect the thickness of the intestinal wall and the presence of minimal amounts of fluid in the peritoneal cavity. In this paper we review the pathogenesis, clinical presentation and imaging of NEC with a particular attention to the emergent role of US in the diagnosis of the disease.

show abstract

Portal venous gas and surgical outcome of neonatal necrotizing enterocolitis

Cited by 75 publications

References 10 publications

Valor preditivo da distensão de alças intestinais em radiografias no prognóstico de enterocolite necrosante

Valor preditivo da distensão de alças intestinais em radiografias no prognóstico de enterocolite necrosante

Necrotising Enterocolitis - epidemiology and imaging

Diagnostic imaging features of necrotizing enterocolitis: a narrative review

Contact Info

Product

Resources

About