Necrotising entero-colitis

Question 1

What is neonatal necrotizing enter-colitis?

Answer 1

Condition where part of the bowel becomes necrotic

Question 2

What can bowel necrosis lead to?

Answer 2

Bowel perforation.

Question 3

What can bowel perforation result?

Answer 3

Peritonitis and shock.

Question 4

What is the initial presentation of necrotising entero-colitis?

Answer 4

• Feeding intolerance
• Abdominal distension
• Bloody stools

Question 5

What can necrotising enter-colitis quickly progress to?

Answer 5

• Abdominal discolouration
• Perforation (hole)
• Peritonitis (inflammation of the peritoneum)

Question 6

What is the main investigation for necrotising entero-colitis?

Answer 6

Abdominal X-ray

Question 7

What can be seen on an x-ray of necrotising enter-colitis?

Answer 7

• dilated bowel loops
• air in the biliary tree
• bowel wall oedema
• pneumatosis intestinalis (intramural gas)
• portal venous gas
• pneumoperitoneum resulting from perforation
• air both inside and outside of the bowel wall (Rigler sign)- confirm diagnosis
• air outlining the falciform ligament (football sign)- confirm diagnosis

Question 8

What 2 signs can be used to confirm the diagnosis of necrotising entero-colitis?

Answer 8

Rigler sign

Football sign

Question 9

What is Rigler sign?

Answer 9

Air both inside and outside of the bowel wall

Question 10

What is Football sign?

Answer 10

Air outlining the falciform ligament

Question 11

What would you look for in the blood of someone with necrotising entero-colitis?

Answer 11

• Full blood count for thrombocytopenia and neutropenia
• CRP for inflammation
• Capillary blood gas will show a metabolic acidosis
• Blood culture for sepsis

Question 12

What would you look for in a full blood count in someone with necrotising entero-colitis?

Answer 12

Thrombocytopenia and neutropenia

Question 13

What will the blood gas of someone with necrotising entero-colitis show?

Answer 13

Metabolic acidosis

Question 14

What is the management of necrotising entero-colitis?

Answer 14

Nil by mouth with IV fluids
Total parenteral nutrition (TPN)
Broad spectrum antibiotics

Question 15

What can be used to drain fluid and gas from the stomach and intestines?

Answer 15

Nasogastric tube

Question 16

What might need to be done in an extreme case of necrotising entero-colitis?

Answer 16

Surgery may be required to remove the dead bowel tissue.

Question 17

What might a child need if significant bowel is removed?

Answer 17

A temporary stoma

Question 18

What are the possible complications of necrotising enter-colitis?

Answer 18

• Perforation and peritonitis
• Sepsis
• Death

Question 19

What is a typical presentation of necrotising enterocolitis?

Answer 19

Bilous vomit
distended abdomen
not feeding
bloood in stool

abdominal x-ray: thickened bowel walls and air in bowel
History: premature rupture of membranes

Question 20

In who does necrotising entero-colitis usually affect?

Answer 20

Premature babies

Question 21

When does necrotising enterocolitis usually occur?

Answer 21

In the second or third week of life

Question 22

What are the main x-ray changes to look for?

Answer 22

dilated loops of bowel
bowel wall oedema
pneumatosis intestinalis (intramural gas)*
pneumoperitoneum (free gas in peritoneal cavity) resulting from perforation*
portal venous gas*