Which finding on abdominal radiography indicates necrotizing enterocolitis (NEC)?

Updated: Dec 27, 2017
  • Author: Shelley C Springer, JD, MD, MSc, MBA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Pneumatosis intestinalis is a radiologic sign pathognomonic of necrotizing enterocolitis (NEC). It appears as a characteristic train-track lucency configuration within the bowel wall. Intramural air bubbles represent gas produced by bacteria within the wall of the bowel. Analysis of gas aspirated from these air bubbles reveals that it consists primarily of hydrogen, suggesting that the bubbles are caused by bacterial fermentation. Carbohydrate (often lactose) fermentation by intestinal flora yields hydrogen and carbon dioxide and a series of short-chain organic acids, which can promote inflammation.

Pneumatosis is present in 70%-80% of patients with NEC, although it may be fleeting or intermittent and is often an early finding. The extent of gas is not correlated with the severity of disease, nor is it specific to NEC. Pneumatosis is also seen in Hirschsprung disease, severe diarrhea, carbohydrate intolerance, and inspissated milk syndrome. (See the images below.)

Pneumatosis intestinalis. Photo courtesy of Loren Pneumatosis intestinalis. Photo courtesy of Loren G Yamamoto, MD, MPH, Kapiolani Medical Center for Women & Children, University of Hawaii, with permission.
Pneumatosis intestinalis. Photo courtesy of Loren Pneumatosis intestinalis. Photo courtesy of Loren G Yamamoto, MD, MPH, Kapiolani Medical Center for Women & Children, University of Hawaii, with permission.
Pneumatosis intestinalis. Photo courtesy of Loren Pneumatosis intestinalis. Photo courtesy of Loren G Yamamoto, MD, MPH, Kapiolani Medical Center for Women & Children, University of Hawaii, with permission.
Pneumatosis intestinalis. Photo courtesy of Loren Pneumatosis intestinalis. Photo courtesy of Loren G Yamamoto, MD, MPH, Kapiolani Medical Center for Women & Children, University of Hawaii, with permission.
Extensive pneumatosis intestinalis. Extensive pneumatosis intestinalis.
Necrotizing enterocolitis totalis. Pneumatosis int Necrotizing enterocolitis totalis. Pneumatosis intestinalis and multiple areas of perforation were seen.
Pneumatosis intestinalis. Pneumatosis intestinalis.

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