DDX of complications of necrotizing enterocolitis

Approach to complications of necrotizing enterocolitis (NEC):

  • Early findings of NEC on AXR may be diffusely dilated loops of bowel or an asymmetrically dilated loop of bowel
  • Later findings of NEC on AXR may be classic triad of pneumatosis intestinalis, portal venous gas, free air
  • Note: some perforations in NEC can be walled off due to surrounding inflammation and not show free air on AXR
  • Note: many cases of NEC have no AXR findings as some findings of NEC on AXR are transient (pneumatosis intestinalis + portal venous gas)
  • Post necrotizing enterocolitis stricture should be suspected in infant with persistently distended abdomen after treatment for NEC and be investigated with enema