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Necrotizing enterocolitis with recurrent hepatic portal venous gas
The Journal of Pediatrics
|March 1, 1976
Summary
Hepatic portal venous gas (HPVG) in premature infants with necrotizing enterocolitis (NEC) may not always require surgery. This case shows survival without intervention, but NEC signs returned with early refeeding.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Radiology
Background:
- Necrotizing enterocolitis (NEC) is a serious condition in premature infants.
- Hepatic portal venous gas (HPVG) is often associated with severe NEC and high mortality.
- Pneumatosis intestinalis is another radiographic sign indicative of bowel distress.
Observation:
- A premature infant diagnosed with necrotizing enterocolitis presented with two episodes of pneumatosis intestinalis.
- Hepatic portal venous gas (HPVG) was detected in both instances.
- Despite the presence of HPVG, a sign traditionally considered ominous, the infant did not undergo surgical intervention.
Findings:
- The infant survived the initial episodes of NEC with HPVG without requiring surgery.
- Clinical and radiographic signs of NEC recurred when enteral feeding was reintroduced before completing 10 days of medical management.
- This suggests a potential link between early refeeding and NEC recurrence.
Implications:
- HPVG in premature infants with NEC may not invariably necessitate surgical intervention.
- Careful timing of enteral feeding resumption is crucial in managing NEC.
- Further research is warranted to establish optimal feeding protocols for NEC patients with HPVG.