Emergency Medical Minute2 Maalis 2021

Podcast 645: Necrotizing Enterocolitis and More

Contributor: Peter Bakes, MD

Educational Pearls:

Necrotizing Enterocolitis (NEC)
- Presents in the first few days of life (often in the NICU) to 3 weeks old
- Risk factors include prematurity, excess feeding, neonatal sepsis
- Pneumatosis Intestinalisis on abdominal xray caused by bacterial translocation into the bowel wall
- Treated with NG tube, bowel rest and surgical resection
Other causes of pediatric abdominal pain
- Malrotation with volvulus
- - Malrotation is caused by failure of intestinal rotation in the 8th-12th week of development
  - Presents with bilious vomiting, which is a surgical emergency in a neonate
  - 90% of cases present in the first year of life, with most of these presenting in the first month
  - Diagnosed with an upper GI series
- Pyloric Stenosis
- - Typically in males <2 months of age who present with signs of dehydration in the setting of non-bilious vomiting
  - Diagnosed with abdominal ultrasound and treated surgically
- Intussusception
- - Typically presents between 2 months and 2 years with a palpable mass in the RUQ
  - Diagnosed with abdominal ultrasound
- Duodenal atresia
- - Congenital stricture in the duodenum
  - Presents with bilious vomiting and a double-bubble on abdominal xray

References

Alwan R, Drake M, Gurria Juarez J, Emery KH, Shaaban AF, Szabo S, Sobolewski B. A Newborn With Abdominal Pain. Pediatrics. 2017 Nov;140(5):e20164267. doi: 10.1542/peds.2016-4267. PMID: 29042421.

Hostetler MA, Schulman M. Necrotizing enterocolitis presenting in the Emergency Department: case report and review of differential considerations for vomiting in the neonate. J Emerg Med. 2001 Aug;21(2):165-70. doi: 10.1016/s0736-4679(01)00371-7. PMID: 11489407.

Summarized by John Spartz, MS3

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