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Necrotizing enterocolitis and volvulus in the premature neonate
J E Boulton1, S H Ein, B J Reilly
1Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Journal of Pediatric Surgery
|September 1, 1989
Summary
Malrotation with volvulus and necrotizing enterocolitis (NEC) are critical surgical conditions in preterm infants. Bilious vomiting is a key indicator of volvulus, which can be misdiagnosed as NEC.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Infant critical care
Background:
- Surgical abdomen in preterm infants requires accurate diagnosis.
- Malrotation with volvulus and necrotizing enterocolitis (NEC) are significant concerns.
- Distinguishing between these conditions is clinically important.
Purpose of the Study:
- To identify factors differentiating malrotation with volvulus from NEC in preterm infants.
- To evaluate the diagnostic accuracy of clinical and radiographic findings.
- To improve early recognition and management of these surgical emergencies.
Main Methods:
- Retrospective study of preterm infants (<37 weeks) with surgical abdomen over 5 years.
- Analysis of clinical presentation, including stool characteristics and vomiting.
- Review of radiographic findings and their correlation with diagnoses.
Main Results:
- NEC infants were more likely to present with systemic illness, bloody stools, tenderness, and thrombocytopenia.
- Bilious vomiting and gastric residuals were specific indicators of volvulus.
- Radiographic signs of NEC showed variable accuracy and reliability in distinguishing conditions.
Conclusions:
- Volvulus is a critical diagnosis in preterm infants that can mimic NEC.
- Bilious vomiting in infants suspected of NEC warrants consideration of volvulus.
- Early recognition of specific clinical signs is crucial for timely intervention.