What is the role of abdominal ultrasonography in the workup of 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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With abdominal ultrasonography, a skilled clinician can identify a larger amount of diagnostic information faster and with less risk to the baby than with the current standard evaluation methods.

Ultrasonography can be used to identify areas of loculation and/or abscess consistent with a walled-off perforation when patients with indolent NEC have scarce gas or a fixed area of radiographic density. Ultrasonography is also excellent for identifying and quantifying ascites. Serial examinations can be used to monitor the progression of ascites as a marker for the disease course.

In addition, ultrasonography can be used to visualize portal air, which can easily be seen as bubbles present in the venous system. Moreover, abdominal ultrasonography has been reported to be more sensitive than plain radiography in the detection of pneumatosis intestinalis. This modality offers the ability to confirm findings of traditional radiographs (ie, pneumatosis intestinalis, portal venous air) with the added ability to better assess the integrity of the intestinal walls, decreased peristalsis, and bowel wall perfusion. Despite its benefits, however, integration of the additional information provided by this modality into clinical decision-making has been slow. [34]

Ultrasonographic assessment of major splanchnic vasculature can help in the differential diagnosis of NEC from other disorders that are either more benign or emergent.

The orientation of the superior mesenteric artery in relationship to the superior mesenteric vein can provide information regarding the possibility of a malrotation with a subsequent volvulus. If a volvulus is present, the artery and vein are twisted and, at some point in their courses, their orientation switches. This abnormality can be detected, even if the rotation is 360⁰, if the full path of the vessels can be observed.

Doppler study of the splanchnic arteries early in the course of NEC can help to distinguish developing NEC from benign feeding intolerance in a mildly symptomatic baby.

A clinical study from Europe and a small series in the United States demonstrated markedly increased peak flow velocity (>1) of arterial blood flow in the celiac and superior mesenteric arteries in early NEC. [35] Such a finding at the presentation of symptoms can further aid in diagnosis and therapy, potentially sparing those individuals at low risk for NEC from unnecessary interventions.

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