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Updated: May 1, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Contrast enema in suspected post-NEC intestinal strictures without direct stenosis signs: a retrospective study of
Jinfeng Hou1, Yong Qin2, Qingshuang Liu1
1Department of General Surgery & Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Objective:
Contrast enema (CE) is widely used for suspected post-NEC intestinal strictures, yet some surgically confirmed strictures show no direct stenosis on CE. We aimed to characterize clinical and CE findings in these cases and identify features associated with multi-segment involvement to inform preoperative management.
Methods:
We retrospectively reviewed 191 infants with surgically confirmed post-NEC intestinal strictures who underwent preoperative CE. Infants were classified as CE-positive (direct stenosis on CE) or CE-negative (no direct stenosis). Based on intraoperative findings, strictures were further categorized as single-segment or multi-segment. Clinical characteristics and radiographic signs were compared between groups.
Results:
Of 191 infants, 153 were CE-positive and 38 were CE-negative. CE-negative infants had a higher rate of prematurity (78.95% vs. 52.94%, P = 0.004) and lower birth weight (median 1960 g vs. 2,530 g, P = 0.001). CE-negative strictures more frequently involved the ileum and right colon, with a markedly higher rate of isolated small-bowel involvement (39.47% vs. 1.31%, P < 0.001). Indirect radiographic signs were common in CE-negative infants, including small-bowel dilatation (73.68% vs. 25.49%, P < 0.001) and microcolon (39.47% vs. 1.31%, P < 0.001). Bead-like/sausage-like appearance was independently associated with multi-segment involvement (OR = 24.90, P < 0.001).
Conclusion:
In surgically confirmed post-NEC strictures without direct stenosis on CE, infants are more often premature with lower birth weight, and lesions tend to involve the ileum and right colon. Indirect CE signs such as small-bowel dilatation and microcolon may support clinical decision-making in CE-negative cases, and bead-like/sausage-like appearance suggests a high likelihood of multi-segment involvement.
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