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Neonatal and General paediatric Surgery
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
The hallmark of the diagnosis is the finding of pneumatosis intestinalis on plain abdominal x-ray. Free air (pneumoperitoneum) is indicative of perforation. Gas in the portal venous system may be a sign of advanced disease (Figs 18.33–18.35).
Necrotizing enterocolitis
Published in Prem Puri, Newborn Surgery, 2017
Stephanie C. Papillon, Scott S. Short, Henri R. Ford
At initial presentation, infants who develop NEC often exhibit nonspecific systemic signs that may prompt a workup for sepsis. Symptoms specific to the gastrointestinal tract are present in over 70% of patients and include feeding intolerance manifested by high gastric residuals or frank vomiting, abdominal distention, and gross or occult blood in the stool, which is seen in up to 60% of patients.2 These symptoms may present postoperatively following the initial stages of cardiac repair for CHD in the full-term infant. As NEC progresses, patients may develop worsening abdominal distention, abdominal wall discoloration, or erythema (Figure 65.3). Within hours, patients can rapidly deteriorate and develop peritonitis with signs of cardiovascular collapse. The diagnosis is often established by radiographic imaging. Standard imaging consists of plain abdominal radiographs. Initial findings may be nonspecific such as dilated loops of intestine and a bowel gas pattern consistent with ileus. Pneumatosis intestinalis is the most common finding observed in patients with NEC (Figure 65.4).1 Portal venous gas is another potential finding that is associated with pan-involvement and an unfavorable outcome (Figure 65.5). The NEC staging system, originally developed by Bell et al., combines the clinical symptoms with radiographic findings and has been used to classify severity of disease and guide therapy.
Thorax
Published in Dave Maudgil, Anthony Watkinson, The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Dave Maudgil, Anthony Watkinson
The following may occur after lung transplantation. True or false? Lung torsion at six weeks.Bronchial dehiscence.Pulmonary embolism in the acute phase.Pneumatosis intestinalis.Recurrence of sarcoidosis in the transplanted lung.
Complications associated with the current sequential pharmacological management of early postnatal hypotension in extremely premature infants
Published in Baylor University Medical Center Proceedings, 2019
Rita P. Verma, Shaeequa Dasnadi, Yuan Zhao, Hegang H. Chen
The following maternal variables were studied: clinical or histological chorioamnionitis, diabetes mellitus, hypertension, receipt of antenatal steroids, and history of substance abuse, including cocaine, narcotics, nicotine, and cannabis. Neonatal data were collected for the first 14 days after birth and included gestational age; birth weight; sex; race; vaginal or cesarean section delivery; Apgar scores at 1 and 5 minutes of life; highest mean airway pressure and fractional inspired oxygen on postnatal days of life 1 and 7; receipt of surfactant in doses >1; patent ductus arteriosus as diagnosed by echocardiogram and treated medically or surgically; air leak syndrome including pneumothorax, pneumomediastinum, and pneumopericardium; necrotizing enterocolitis; spontaneous intestinal perforation; and intraventricular-periventricular hemorrhage of any grade. The diagnosis of necrotizing enterocolitis was made if the infant presented with stage IIA or higher of the modified Bell’s criteria. The diagnosis of spontaneous intestinal perforation was made with radiologic findings of pneumoperitoneum in the absence of pneumatosis intestinalis and portal venous air, further confirmed by the surgical findings of an isolated bowel perforation with an otherwise visually and histopathologically normal bowel. The neonatal outcome variables included in the study were periventricular leukomalacia, ventriculomegaly, death before discharge, and oxygen dependence at 36 postmenstrual weeks of life (bronchopulmonary dysplasia).
A case report of gastric emphysema induced by noninvasive positive airway pressure
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Fahad Malik, Natalia Lattanzio, Karen Veloso, Jay Nfonoyim
During hospitalization, the patient was found to be in respiratory distress with use of accessory muscles. The code status of the patient stated not to resuscitate or intubate. The saturation was 93% on room air. Chest x-ray at the time revealed an infiltrate consistent with pneumonia. He was started on empiric treatment with vancomycin and piperacillin-tazobactam for seven days, methylprednisolone, bronchodilators, and non-rebreather mask with FiO2 of 40% for the treatment of hypoxic respiratory failure and hospital-acquired pneumonia. On hospital day 12, he was found to be in respiratory distress now requiring BiPAP machine. This machine was used for approximately 18 h. The diagnosis of pulmonary embolism was excluded by performing a CT angiogram. An incidental finding of portomesenteric venous gas was noted. Therefore, a CT of the abdomen and pelvis was obtained. This study showed large amounts of stool burden throughout the gastrointestinal tract and thickening of stomach walls (body and fundus) shown in Figures 1 and 2 (inset). This was suggestive of pneumatosis intestinalis and EG.
Bowel perforation from malignant atrophic papulosis treated with eculizumab
Published in Baylor University Medical Center Proceedings, 2021
Ajithraj Sathiyaraj, Priyanga Jayakumar, Matthew R. McGlennon, John F. Eckford, Sandy Itwaru Anne
He was discharged home following the procedure and was scheduled to receive eculizumab 1200 mg every 2 weeks. Approximately 6 weeks after discharge, he began to decline functionally and had episodes of diarrhea leading to hyponatremia. A repeat CT scan of the chest/abdomen/pelvis showed extensive pneumatosis intestinalis of the large bowel with evidence of portal venous gas, concerning for bowel ischemia. He was readmitted to the hospital. Evaluation by general surgery led to the decision not to pursue further surgical intervention due to the high risk of mortality associated with his state. During this admission, goals of care were addressed, and he signed a do-not-resuscitate order and was referred to hospice care. The patient died before he could be discharged.