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Eur J Pediatr Surg 2011; 21(1): 12-17
DOI: 10.1055/s-0030-1265204
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Portal Venous Gas Detected by Ultrasound Differentiates Surgical NEC from Other Acquired Neonatal Intestinal Diseases

B. Bohnhorst1 , J. F. Kuebler2 , G. Rau3 , S. Gluer2 , B. Ure2 , M. Doerdelmann3
  • 1Hannover Medical School, Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover, Germany
  • 2Hannover Medical School, Pediatric Surgery, Hannover, Germany
  • 3Diakonissenanstalt zu Flensburg, Department of Pediatrics, Flensburg, Germany
Further Information

Publication History

received April 14, 2010

accepted after revision August 16, 2010

Publication Date:
15 October 2010 (online)

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Abstract

Background: The definite clinical diagnosis of acquired neonatal intestinal diseases (ANID) is a challenge, usually met by applying Bell's or, more recently, Gordon's classification. Both classifications incorporate radiological pneumatosis intestinalis (PI) as a cornerstone of the NEC diagnosis. However, PI may be absent or difficult to identify by abdominal X-ray. Portal venous gas detected by ultrasound (PVG-US) has been proposed as another characteristic of NEC, but its incidence in other entities of ANID remains unknown.

Objective: To determine whether PVG-US and Gordon's classification can help to differentiate between NEC and other ANID, especially SIP.

Methods: Retrospective analysis of the data of 83 infants, who underwent laparotomy for a clinical diagnosis of ANID was performed. The results of PVG-US and other markers of ANID were compared with the operative result, defined as the gold standard for diagnosis.

Results: The NEC diagnosis was confirmed in 28/83 infants and PVG-US was present in 23 (82%) of those patients prior to operation. PVG-US was detected in 2 patients without NEC (one volvulus, one SIP), resulting in an 82% sensitivity and a 96% specificity. The sensitivity and specificity of radiological PI for patients with NEC was lower (75 and 91%), but the combination of PVG-US and radiological PI increased the sensitivity for NEC detection to 89%. Gordon's classification had a sensitivity of 93% and a specificity of 92% for NEC diagnosis.

Conclusion: Screening for PVG-US and Gordon's classification are valid tools to differentiate between NEC and other ANID including SIP. Although an effect of these proposed diagnostic tools on treatment regimen and operative management has yet to be verified, the improvement in diagnosing ANID is certainly valuable.

Key words

necrotizing enterocolitis - portal venous gas - Gordon's classification - sensitivity - specificity

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Correspondence

Dr. Bettina Bohnhorst

Hannover Medical School

Department of Pediatric

Pulmonology

Allergology and Neonatology

Carl-Neubergstraße 1

30625 Hannover

Germany

Phone: +49 511 532 9121

Fax: +49 511 532 3895

Email: bohnhorst.bettina@mh-hannover.de

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