Current prognosis in necrotizing enterocolitis with portal vein gas.

OBJECTIVE

To investigate anecdotal reports that portal vein gas in necrotizing enterocolitis is no longer associated with a poor prognosis.

PATIENTS AND METHODS

Twelve cases of neonatal necrotizing enterocolitis with portal vein gas from 1988 to 1994 were identified retrospectively from the radiology dictation system in a large university hospital.

RESULTS

Two distinct groups of patients with portal vein gas in necrotizing enterocolitis were identified. In 3 of the 12 children, portal vein gas was identified on abdominal films after the diagnosis of necrotizing enterocolitis. These infants had no serious sequelae. By contrast, in 8 of the 9 infants with portal vein gas seen on the initial film at presentation, emergent surgery was required. Four of these infants died from complications of necrotizing enterocolitis and 2 died from sepsis related to total parenteral nutrition. The remaining 2 children have short bowel syndrome, 1 is dependent on total parenteral nutrition and 1 requires continuous gastrostomy tube feedings.

CONCLUSION

The children with portal vein gas on the initial abdominal film continue to have a guarded prognosis.