Rose Holly S, Monroe Alexandra K, Titus M Olivia, Kane Ian D
Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
Department of Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina.
J Emerg Med. 2020 Jun;58(6):e255-e258. doi: 10.1016/j.jemermed.2020.02.003. Epub 2020 Mar 31.
Necrotizing enterocolitis (NEC) is a gastrointestinal emergency characterized by ischemic necrosis of the intestinal mucosa, leading to bacterial translocation and pneumatosis of the bowel wall. Although there are numerous studies on clinical presentations of preterm NEC, approximately 10-15% of cases occur in full-term neonates. Nearly 10% of all infants with NEC will develop a rapidly progressive and fatal form of the disease called NEC totalis.
A 24-day-old term male infant presented to the Emergency Department (ED) with emesis. The infant was ill-appearing with a tense abdomen and had significant tachycardia and hypotension. The patient was immediately volume resuscitated and started on empiric antibiotics. Initial radiographs revealed no evidence of bowel obstruction or pneumatosis. Pediatric Surgery was consulted, and upper gastrointestinal and abdominal computed tomography scans were obtained, which were nondiagnostic. The patient was taken to the operating room for an exploratory laparotomy after continued clinical deterioration and was diagnosed with NEC totalis and passed away within 6 days. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates an uncommon presentation of NEC in an otherwise healthy term neonate without any known risk factors. The diagnosis of NEC is challenging because imaging studies may be inconclusive, particularly early in the clinical course. Regardless of the etiology, all infants who present to the ED with signs and symptoms of severe gastrointestinal distress should be treated with basic emergency care, including rapid fluid resuscitation, empiric antibiotics, bowel decompression, and early surgical consultation.
坏死性小肠结肠炎（NEC）是一种胃肠道急症，其特征为肠黏膜缺血坏死，可导致细菌移位及肠壁积气。尽管已有大量关于早产儿坏死性小肠结肠炎临床表现的研究，但约10% - 15%的病例发生在足月儿。所有坏死性小肠结肠炎患儿中近10%会发展为一种迅速进展且致命的疾病形式，即全坏死性小肠结肠炎。
一名24日龄的足月男婴因呕吐被送至急诊科。该婴儿看起来病情严重，腹部紧张，有显著的心动过速和低血压。立即对患者进行了液体复苏，并开始经验性使用抗生素。初始X线片未显示肠梗阻或肠壁积气的证据。咨询了小儿外科医生，并进行了上消化道和腹部计算机断层扫描，但结果未明确诊断。在临床持续恶化后，该患者被送往手术室进行剖腹探查，被诊断为全坏死性小肠结肠炎，并在6天内死亡。急诊科医生为何应了解此情况？：本病例展示了坏死性小肠结肠炎在一名无任何已知危险因素的健康足月新生儿中的罕见表现。坏死性小肠结肠炎的诊断具有挑战性，因为影像学检查可能无法得出明确结论，尤其是在临床病程早期。无论病因如何，所有因严重胃肠道不适症状就诊于急诊科的婴儿都应接受基本的急诊治疗，包括快速液体复苏、经验性使用抗生素、肠道减压及早期外科会诊。
