Abstract
Background
Necrotizing enterocolitis (NEC) is a gastrointestinal emergency characterized by ischemic
necrosis of the intestinal mucosa, leading to bacterial translocation and pneumatosis
of the bowel wall. Although there are numerous studies on clinical presentations of
preterm NEC, approximately 10–15% of cases occur in full-term neonates. Nearly 10%
of all infants with NEC will develop a rapidly progressive and fatal form of the disease
called NEC totalis.
Case Report
A 24-day-old term male infant presented to the Emergency Department (ED) with emesis.
The infant was ill-appearing with a tense abdomen and had significant tachycardia
and hypotension. The patient was immediately volume resuscitated and started on empiric
antibiotics. Initial radiographs revealed no evidence of bowel obstruction or pneumatosis.
Pediatric Surgery was consulted, and upper gastrointestinal and abdominal computed
tomography scans were obtained, which were nondiagnostic. The patient was taken to
the operating room for an exploratory laparotomy after continued clinical deterioration
and was diagnosed with NEC totalis and passed away within 6 days.
Why Should an Emergency Physician Be Aware of This?
This case demonstrates an uncommon presentation of NEC in an otherwise healthy term
neonate without any known risk factors. The diagnosis of NEC is challenging because
imaging studies may be inconclusive, particularly early in the clinical course. Regardless
of the etiology, all infants who present to the ED with signs and symptoms of severe
gastrointestinal distress should be treated with basic emergency care, including rapid
fluid resuscitation, empiric antibiotics, bowel decompression, and early surgical
consultation.
Keywords
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Article info
Publication history
Published online: March 31, 2020
Accepted:
February 16,
2020
Received in revised form:
January 28,
2020
Received:
November 12,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
