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Medicine (MD/DO)
Intestinal Disorders
Necrotizing Enterocolitis Diagnosis and Management

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Necrotizing Enterocolitis Diagnosis and Management

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Necrotizing Enterocolitis Diagnosis and Management

Necrosis-crow Enter-intestine In-flames with Diagnostic-computer and Manager
Necrotizing enterocolitis is a transmural necrotizing inflammation of the intestinal wall. Diagnostic workup includes complete blood count, blood cultures, and imaging. On abdominal imaging, pneumatosis intestinalis might be seen in addition to increased bowel wall thickness. Management principles include putting the patient on NPO status with nasogastric tube suction, broad spectrum antibiotics until culture results become available, and surgery if necessary.
Complete Blood Count (CBC)
Blood Cell Count-dracula

In the initial workup of this disease, a complete blood count (CBC) should be ordered. This might show a typical inflammatory state and helps to quickly evaluate for risk of sepsis and shock.

Blood Cultures
Blood Petri-dish

Patients with NEC should have a blood culture performed to direct antibiotic treatment.

Pneumatosis Intestinalis
Balloon Floating with Intestine

On abdominal imaging, pneumatosis intestinalis might be seen. This is defined as bead-like or bubble-shaped intramural air pockets. If perforation has occurred, pneumoperitoneum may also be seen.

Increased Bowel Wall Thickness
Up-arrow Bowel-bowl on Thick Wall

Abdominal imaging may also show a thickening of the gut wall and air-fluid levels. Ultrasound can be useful to measure bowel wall thickness if radiographs are inconclusive.

NPO with NG Tube to Suction
NPO-zipper-mouth with NG Tube to Suction

If NEC is suspected, the patient is immediately switched to parenteral nutrition i.e. all oral medication is discontinued. A gastric drainage tube is placed and connected to suction to allow decompression.

Broad Spectrum Antibiotics
Broad-spectrum of Colors with ABX-guy

Since NEC often leads to sepsis, patients are given broad-spectrum antibiotics as empiric treatment. After culture results are available, antibiotics are tailored.


Surgical intervention is indicated in the case of perforation, but also in the advanced stage of the disease, and is intended to prevent further intestinal distension and thus improve the perfusion of the intestinal wall. If possible, bowel that looks necrotic should be left in place and resected only as a last resort, since large parts of the bowel can recover.


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