Diagnostic imaging features of necrotizing enterocolitis: a narrative review

被引:44
作者
Esposito, Francesco [1 ]
Mamone, Rosanna [1 ]
Di Serafino, Marco [2 ]
Mercogliano, Carmela [3 ]
Vitale, Valerio [4 ]
Vallone, Gianfranco [5 ]
Oresta, Patrizia [1 ]
机构
[1] Santobono Pausilipon Children Hosp, Dept Radiol, Naples, Italy
[2] San Carlo Hosp, Dept Emergency Radiol, Potenza, Italy
[3] San Carlo Hosp, Dept Neonatol, Potenza, Italy
[4] A Manzoni Hosp, Azienda Socio Sanitaria Territoriale Lecco, Dept Imaging & Radiat therapy, Lecce, Italy
[5] Univ Hosp Federico II, Dept Radiol, Sect Pediat Diagnost, Naples, Italy
关键词
Necrotizing enterocolitis (NEC); ultrasound (US); newborn; bowel disease; BIRTH-WEIGHT INFANTS; PORTAL VENOUS GAS; RADIOGRAPHIC FINDINGS; ABDOMINAL ULTRASOUND; PREMATURE-INFANTS; GASTRIC RESIDUALS; OUTCOMES; SURGERY; EPIDEMIOLOGY; PATHOGENESIS;
D O I
10.21037/qims.2017.03.01
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Necrotizing enterocolitis (NEC) is an inflammatory process, characterized by intestinal necrosis of variable extension, leading to perforation, generalized peritonitis and death. The classical pathogenetic theory focuses on mucosal damage related to a stress induced intestinal ischemia leading to mucosal injury and bacterial colonization of the wall. A more recent hypothesis emphasizes the role of immaturity of gastrointestinal and immune system, particularly of the premature, responsible of bowel wall vulnerability and suffering. NEC is the most common gastrointestinal emergency in the newborn, with a higher incidence in the preterm; improvement of neonatal resuscitation techniques enables the survival of premature of very low birth weight (VLBW) with prolongation of hospital stay for perinatal and neonatal care and a higher risk of NEC. Clinical presentation of NEC in newborn ranges from mild forms with moderate gastrointestinal tract disorder and that can heal spontaneously, to very serious forms with fulminant course characterized by perforation, peritonitis, sepsis, disseminated intravascular coagulation (DIC) and shock. Imaging modality in the diagnosis of NEC is historically represented by the plain-film abdominal radiographs which can be performed every 6 hours because of the rapid evolution that may occur in the patient's clinical condition. However ultrasound (US), in recent years, is playing an increasingly important role in the evaluation of early stages of the disease as it provides images in real time of the abdominal structures being able to assess the presence and validity of peristalsis of the bowel loops, detect the thickness of the intestinal wall and the presence of minimal amounts of fluid in the peritoneal cavity. In this paper we review the pathogenesis, clinical presentation and imaging of NEC with a particular attention to the emergent role of US in the diagnosis of the disease.
引用
收藏
页码:336 / 344
页数:9
相关论文
共 52 条
  • [1] NEONATAL NECROTIZING ENTEROCOLITIS - THERAPEUTIC DECISIONS BASED UPON CLINICAL STAGING
    BELL, MJ
    TERNBERG, JL
    FEIGIN, RD
    KEATING, JP
    MARSHALL, R
    BARTON, L
    BROTHERTON, T
    [J]. ANNALS OF SURGERY, 1978, 187 (01) : 1 - 7
  • [2] NECROTIZING ENTEROCOLITIS IN THE PREMATURE INFANT
    BERDON, WE
    GROSSMAN, H
    BAKER, DH
    MIZRAHI, A
    BARLOW, O
    BLANC, WA
    [J]. RADIOLOGY, 1964, 83 (05) : 879 - 887
  • [3] Necrotizing enterocolitis: An update
    Berman, Loren
    Moss, R. Lawrence
    [J]. SEMINARS IN FETAL & NEONATAL MEDICINE, 2011, 16 (03) : 145 - 150
  • [4] Necrotizing Enterocolitis: Risk Factor Analysis and Role of Gastric Residuals in Very Low Birth Weight Infants
    Bertino, Enrico
    Giuliani, Francesca
    Prandi, Giovanna
    Coscia, Alessandra
    Martano, Claudio
    Fabris, Claudio
    [J]. JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 2009, 48 (04) : 437 - 442
  • [5] Usefulness of abdominal ultrasound in diagnosing necrotising enterocolitis
    Bohnhorst, Bettina
    [J]. ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, 2013, 98 (05): : F445 - F450
  • [6] The radiology of necrotizing enterocolitis
    Buonomo, C
    [J]. RADIOLOGIC CLINICS OF NORTH AMERICA, 1999, 37 (06) : 1187 - +
  • [7] BURAS R, 1986, PEDIATRICS, V78, P273
  • [8] Gastric residuals and their relationship to necrotizing enterocolitis in very low birth weight infants
    Cobb, BA
    Carlo, WA
    Ambalavanan, N
    [J]. PEDIATRICS, 2004, 113 (01) : 50 - 53
  • [9] Radiologists' agreement when using a 10-point scale to report abdominal radiographic findings of necrotizing enterocolitis in neonates and infants
    Coursey, Courtney A.
    Hollingsworth, Caroline L.
    Gaca, Ana M.
    Maxfield, Charles
    DeLong, David
    Bisset, George, III
    [J]. AMERICAN JOURNAL OF ROENTGENOLOGY, 2008, 191 (01) : 190 - 197
  • [10] Radiographic Predictors of Disease Severity in Neonates and Infants With Necrotizing Enterocolitis
    Coursey, Courtney A.
    Hollingsworth, Caroline L.
    Wriston, Cooper
    Beam, Craig
    Rice, Henry
    Bisset, George, III
    [J]. AMERICAN JOURNAL OF ROENTGENOLOGY, 2009, 193 (05) : 1408 - 1413