Characteristic Radiological findings in Preterm Infants with Missed Intestinal Perforation

Sivasankar Jayakumar, Nitin Patwardhan

Abstract


BACKGROUND: Pneumoperitoneum on radiological imaging is typical in intestinal perforation in necrotizing enterocolitis [NEC]. However, it is not seen in all cases and intestinal perforation is missed on occasions. We present a series of preterm infants with characteristic x-ray findings that on exploration revealed missed intestinal perforation.

METHODS: Retrospective review of neonates with intra-operative diagnosis of intestinal perforation which was missed on x-ray abdomen over a period of 6 months is being presented here.

RESULTS: Three neonates born at 24 (24-30) weeks of gestation were identified. PDA was noted in all 3 patients and they required ventilator and inotropic support. Feeds were commenced at 5 (2-7) days of life. All three patients were treated for NEC. Surgical opinion was sought in view of localized gas shadow in a fixed position seen on repeated x-rays in all three patients. All three patients had laparotomy and small bowel resection with ileostomy formation at a mean age of 26 (24-46) days. Intra-operatively, small bowel perforation and adjacent pseudocysts filled with air and intestinal contents were noted in all 3 patients. Post-operatively full feeds were established in all patients.

CONCLUSION: In premature infants with NEC, intestinal perforation can be missed on occasions. Our patients interestingly, developed characteristic abdominal x-ray findings that in our experience should prompt for surgical intervention.


Keywords


Missed intestinal perforation, Pseudocyst, Necrotizing enterocolitis, Preterm, Neonate

Full Text:

HTML PDF


DOI: http://dx.doi.org/10.21699/jns.v3i3.159

Refbacks

  • There are currently no refbacks.




Copyright (c) 2014 Journal of Neonatal Surgery

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

The Journal of Neonatal Surgery has been indexed Google Scholar, NewJour, Open J-gate, Science Central, eDoctoronline, Ulrichsweb, Scirus, JournalTOCs, ResearchGate, Scribed, FreeJournalAct, Anoox, News-Digest, CORE.

EL-MED-Pub Publishers