Neonatal necrotizing enterocolitis: air in Morison pouch

Area of Science:

• Pediatric Surgery
• Neonatal Imaging
• Gastroenterology

Background:

• Necrotizing enterocolitis (NEC) is a critical condition in newborns.
• Pneumoperitoneum is a known complication of NEC, often requiring surgery.
• Early detection of NEC complications is vital for patient outcomes.

Purpose of the Study:

• To identify Morison pouch air as an early indicator of pneumoperitoneum in NEC.
• To highlight the significance of this finding in neonatal surgical emergencies.
• To increase awareness of this subtle radiographic sign among clinicians.

Main Methods:

• Retrospective review of six newborn infants diagnosed with NEC.
• Radiographic analysis focusing on the presence and appearance of air in Morison pouch.
• Comparison of findings with existing literature on NEC and pneumoperitoneum.

Main Results:

• Air confined to Morison pouch was observed in six NEC patients as an early sign of pneumoperitoneum.
• This triangular lucency in the right upper quadrant can be mistaken for bowel gas.
• Literature review found no prior reports linking Morison pouch air to NEC.

Conclusions:

• Air in Morison pouch is a potentially common, yet under-recognized, sign of pneumoperitoneum in NEC.
• Detection of Morison pouch air warrants the same surgical consideration as other pneumoperitoneum signs.
• Increased radiologist and clinician awareness can improve early diagnosis and management of NEC.