Necrotizing enterocolitis

Background

• Abreviation: NEC
• Intestinal necrosis in previously well infant
• Predominantly affects preemies; 10-15% occurs in full-term pts

Diagnosis

• Poor feeding, lethargy, abd distention/tenderness
• Sepsis, pneumoperitoneum
• Stool is +/- heme +

Work-Up

Labs

• CBC
• Chem
• Sepsis evaluation
• Coags

Imaging

• Cross-table lateral to detect free air
  • Pneumatosis intestinalis, pneumobilia, pneumoperitoneum, sentinel loops, portal gas

Radiography

• Pneumatosis is hallmark
  • Get KUB in supine position and left lat decubitus

Differential Diagnosis

• Sepsis
• Pneumonia
• malro/volvulus
• feeding intolerance (exclusion)

Pediatric Abdominal Pain

0–3 Months Old

• Emergent
  • Necrotizing Enterocolitis
  • Volvulus
  • Testicular torsion
  • Inguinal hernia
    • Incarcerated hernia
  • Trauma
  • Pyloric stenosis
  • Toxic megacolon
  • Hirschsprung's Disease
• Nonemergent
  • Constipation
  • Acute Gastroenteritis
  • Colic

3 mo–3 y old

• Emergent
  • Intussusception
  • Testicular Torsion
  • Trauma
  • Volvulus
  • Appendicitis
  • Toxic megacolon
  • Vaso-occlusive crisis
• Nonemergent
  • Acute Gastroenteritis
  • Constipation
  • Urinary tract infection
  • Henoch-Schonlein purpura

3 y old–adolescence

• Emergent
  • Appendicitis
  • DKA
  • Vaso-occlusive crisis
  • Toxic ingestion
  • Testicular Torsion
  • Ovarian Torsion
  • Ectopic Pregnancy
  • Trauma
  • Toxic megacolon
  • Inflammatory bowel disease
  • Gastric ulcer disease
  • Ovarian cyst
  • Pregnancy
  • Pancreatitis
  • Cholecystitis
  • Intussusception (to age 6)
• Nonemergent
  • Constipation
  • Acute Gastroenteritis
  • Nonspecific viral syndrome
  • Streptococcus pharyngitis
  • Urinary tract infection
  • Pneumonia
  • Renal Stone
  • Henoch-Schonlein purpura
  • Inflammatory bowel disease
  • Vulvovaginitis

Treatment

1. NPO
2. Aggressive IV hydration
3. Amp/gent/clinda x 48 hrs
4. Surgery consult

See Also

Abdominal Pain (Peds)

Source

Tintinalli