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When clinical course contradicts images: necrotising enterocolitis
  1. George T Vasileiadis1,
  2. Stephen Wardle2
  1. 1
    The University of Nottingham, Academic Division of Child Health, Queen’s Medical Centre, Nottingham NG7 2UH, UK
  2. 2
    Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham NG7 2UH, UK
  1. George T Vasileiadis, georgios.vasileiadis{at}

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A male infant was born at 33 weeks’ gestation by spontaneous labour and caesarean section for breech presentation. There were no antenatal/perinatal concerns and the birth weight was 2160 g. The child initially had an uncomplicated course and reached full feeds on the 6th day after birth. Thereafter, he started having small yellow vomits, and on the 11th day he presented with a distended abdomen and lower gastrointestinal bleeding. The C-reactive protein (CRP) rose to 59 mg/l but the infant remained clinically stable. The abdominal x ray revealed portal vein gas and extensive pneumatosis intestinalis involving most of the bowel and stomach. The appearances were those of extensive necrotising enterocolitis (NEC). There was no perforation and in view of the extent of injury, surgery was not performed. The infant continued in a clinically stable condition and remained 10 days on parenteral nutrition and antibiotics. On the 24th day CRP decreased to <3 mg/l, the patient had a normal x ray and he was restarted on feeds. Five days later he was back on full feeds. Full blood count, clotting studies, septic and viral screen were and remained all negative. After follow-up the infant was discharged with no concerns.

NEC is a neonatal complication, characterised by inflammation and necrosis of the intestine. Sepsis, immaturity of intestinum and ischaemia are factors that have been associated with NEC.1 Usually, the extent of pneumatosis intestinalis (the presence of intramural gas) shown in our patient and the presence of portal vein gas indicate severe NEC.2,3 In the case presented, the clinical course of NEC was and remained mild despite the surprisingly extensive and fulminant radiological changes.

Figure 1

x Ray demonstrating evidence of extensive pneumatosis intestinalis and portal vein gas.



  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication.