Arch Dis Child Fetal Neonatal Ed 98:F132 doi:10.1136/fetalneonatal-2011-301257
  • Images in neonatal medicine
  • Images in neonatal medicine

An unusual acute abdominal swelling in a preterm baby with perforated necrotising enterocolitis

  1. Shree Vishna Rasiah1
  1. 1Neonatal Unit, Birmingham Women's Hospital, Birmingham, UK
  2. 2Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
  1. Correspondence to Lakshmi Podugu, Birmingham Women's Hospital, Neonatal Unit, Mindelson Way, Edgabston, Birmingham B15 2TG, UK; lpodugu{at}
  • Received 13 November 2011
  • Accepted 20 February 2012
  • Published Online First 3 May 2012

Case History

A 24-week gestation baby was managed conservatively at 23 days of life for necrotising enterocolitis (NEC) (Bell's stage 1). On day 3 of treatment, she developed an acute, localised, anterior abdominal wall swelling just to the right of the midline (figure 1). Her clinical condition had not worsened. This swelling was soft and easily reducible. We suspected that the bowel had herniated through a defect in the abdominal musculature. A lateral shoot-through abdominal x-ray suggested possible bowel herniation (figure 2). She was immediately referred to the paediatric surgeon and underwent laparotomy.

Figure 1

The unusual appearance of the anterior abdominal swelling.

Figure 2

Lateral abdominal X-ray taken at the time of the swelling.

At surgery, she was found to have a perforation and necrosis of the terminal ileum from NEC. There was an intra-abdominal abscess which had eroded through the anterior abdominal wall and resulted in a collection of intra-abdominal free air subcutaneously. The patient had a burst abdomen 3 days postoperatively which was managed by wound debridement, revision of stoma and closure of the abdomen. Eight days later, there was a superficial wound dehiscence which was managed conservatively. The patient eventually tolerated full enteral feeding despite stoma prolapse. The stoma was closed 4 months later.

This is a very unusual presentation of perforated NEC where the free air was masquerading as an acute abdominal wall hernia. We are unaware of any previous case reports in the literature with a similar presentation.


  • Competing interests None.

  • Patient Consent Obtained from the parents.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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