The radiology of neonatal necrotizing enterocolitis (NEC). A review of 47 cases and the literature.

The radiological findings in 47 neonates with necrotizing enterocolitis (NEC) are reviewed. The presence of nonspecific, generalized bowel dilatation is stressed as being an important sign in early diagnosis and the progress of the distribution of the dilated loops is important in evaluating progress of the disease process. It is thus the key to the radiology of NEC. Intramural gas and portal venous gas are not always related to the severity of the disease and their disappearance is not always related to clinical improvement. These signs are therefore poor prognostic indicators. Important radiological indications for surgery besides free intraperitoneal gas and free fluid include: 1. diminished bowel gas with asymmetric loops, and 2. persistent dilated loops. Because of the number of colonic strictures seen at our hospital we advise routine barium enemas (several weeks after the acute phase) in all infants who have had NEC. Following bowel resection contrast studies of both distal and proximal remaining bowel are essential to exclude further stricture formation prior to final reanastomosis.