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This is Pediatrics week 2 case number

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one and the diagnosis for this case is

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necrotizing enterocolitis.

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Now as you know, necrotizing enterocolitis or neck is

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a bacterial infection of the bowel.

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Typically the small bowel of newborns and

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especially children born

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prematurely. So it's those patients,

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who are

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Quite premature whose bowel is especially at

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risk and this is a KUB radiograph, which

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is been performed on a four week old.

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And we can see that there's a suction catheter

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that courses down the midline and terminates over the left

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Hemi abdomen but more importantly we can

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see multiple areas of Interest throughout

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these Loops of bowel in

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the left Hemi abdomen.

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As you can see me outlining here, but also over in

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the right Hemi abdomen and what we're

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actually seeing are abnormal Lucy

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some of which appear almost bubbly and

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some of which are quite linear and follow the expected Contour

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of the bowel wall.

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And this is air but it's not intraluminal air

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as we would like to see in bowel. It

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is submucosal air. So the infection by

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the bacteria into the bowel wall causes necrosis

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of the bow wall and

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air dissects under the mucosal layer

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of the bowel.

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And into the muscularis and

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into eventually the mesentery of

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the bowel and that gas can finally dissect into

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the veins of the mesentery all

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the way back through the mesentery veins to the portal vein

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and you can find loosen sees in

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the liver of portal Venus gas. This is

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a very concerning finding and when you have extensive linear

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Lucy's throughout the bowel as we see

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here that bowel is at risk for perforation perforation,

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of course would give us free intra peritoneal

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air and here we have a lateral decubitus film

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a left lateral decubitus film. We

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perform radiographic Imaging in this position in

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the hope that air will rise to the non-dependent side of

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the abdomen and would reveal itself. In this

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case. We don't see free and prepare to Neil air, but this patient is

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at high risk, and we need to continue to

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monitor them radiographically to evaluate for

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that as soon as we see it. Most likely they'll be

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going

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Surgery because they have necrotic bowel.

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Even on this lateral decubitus film. We can see abnormal

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lucencies circumferentially surrounding

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this piece of bowel here

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and elsewhere in the abdomen on both sides.

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So the key things to be aware of is Are there specific radiographic

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signs of necrotizing enterocolitis submucosal

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pneumatosis portal

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venous gas, or worst of all perforated bowel

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leading to free and repair tineal air.

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But just because we don't have those findings doesn't

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mean the patient doesn't have necrotizing intro

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colitis. So the thing to be mindful of is the

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bowel gas pattern. Is it normal? Does it

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look abnormally distended to the loops of bowel hold their

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same exact position and shape over multiple days.

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These are concerning signs not quite specific

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signs. So what we see here is the

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neumatosis intestinalis specific for this

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infection, and that's the end of the case.