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Updated: Jun 13, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Acute mesenteric ischaemia: a rare complication mimicking necrotising enterocolitis in a premature infant
Siew-Boon Chan1, Benjamin Wei-Liang Ng2,3, Chae-Hee Chieng2,3
1Department of Paediatrics, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia siewboonchan0104@gmail.com.
Abstract:
Acute mesenteric ischaemia (AMI) is a life-threatening gastrointestinal complication uncommonly described in premature infants. The diagnosis of AMI is challenging and may be delayed due to the limitation of accurate diagnostic imaging and non-specific clinical signs. Furthermore, AMI can be misdiagnosed as necrotising enterocolitis (NEC) due to the overlapping clinical and radiological features. Though known to be associated with high mortality rates, early recognition and intervention can improve the survival rates in infants with AMI. We describe a case of a premature infant who presented with an acute abdomen and haemodynamic collapse, initially treated for NEC but later diagnosed with AMI intraoperatively. Due to the extensive bowel necrosis, surgical intervention was rendered futile and the infant finally succumbed to the disease.
Insights
Acute mesenteric ischaemia (AMI) is a rare but fatal condition in premature infants. Delayed diagnosis, often mistaken for necrotising enterocolitis (NEC), significantly impacts survival rates.
Area of Science:
- Neonatalogy
- Gastroenterology
- Pediatric Surgery
Background:
- Acute mesenteric ischaemia (AMI) is a severe gastrointestinal complication rarely seen in premature infants.
- Diagnosis is difficult due to non-specific signs and imaging limitations.
- AMI can be misdiagnosed as necrotising enterocolitis (NEC) due to similar clinical and radiological features.
Observation:
- A premature infant presented with acute abdomen and haemodynamic collapse.
- Initial treatment was for NEC, but intraoperative findings revealed AMI.
- Extensive bowel necrosis precluded successful surgical intervention.
Findings:
- The case highlights the diagnostic challenges of AMI in neonates.
- Overlapping symptoms with NEC can lead to delayed or incorrect diagnosis.
- High mortality associated with AMI underscores the need for early recognition.
Implications:
- Improved diagnostic strategies for AMI in premature infants are crucial.
- Early detection and intervention are vital for improving survival outcomes.
- This case emphasizes the critical need to consider AMI in neonates with acute abdominal emergencies.
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