The radiology of necrotizing enterocolitis

Imaging of necrotizing enterocolitis is frustrating, with no single imaging test that is both sensitive and specific for the diagnosis. Early, nonspecific findings on plain abdominal films before development of pneumatosis intestinalis is enough evidence in the proper clinical setting to institute medical treatment of necrotizing enterocolitis. Subsequent development of pneumatosis intestinalis will help confirm the clinical diagnosis, but treatment should not be withheld for its development. Delayed complications of necrotizing enterocolitis can be diagnosed by contrast enema examinations, and ultrasound is a helpful additional test in equivocal cases.