The most severe complication of necrotizing enterocolitis (NEC) is bowel perforation. Identification of neonates at high risk for perforation and optimization of radiologic imaging to identify bowel perforation are necessary to reduce the high mortality rate associated with this catastrophic event. One hundred and fifty-five cases of NEC were seen at our institution during a 5.5-year period. Nineteen (12%) progressed to perforation. A review of surgical findings, autopsy results and radiographs from these patients shows only 63% had radiographic evidence of free air in the peritoneal cavity at the time of perforation. Twenty-one percent had radiographic evidence of ascites but no pneumoperitoneum, and 16% had neither free air nor ascites. Thus purely radiographic criteria for bowel perforation in NEC are imprecise, and paracentesis is mandatory in NEC patients with ascites or clinical findings indicative of peritonitis. Timing of radiographic studies and site of bowel involvement are also important. Seventy-nine percent of perforations occurred by 30 h from confirmation of diagnosis (by clinical or radiographic criteria). Surgery or autopsy revealed involvement of the ileo-cecal region in 89% of cases with the actual site of perforation occurring in this area in 58% of patients.
Coronary artery aneurysms are the most serious complication of Kawasaki disease, and periodic screening examinations are necessary. Two-dimensional (2D) echocardiography represents the standard screening method; however, visualization of the distal coronary arteries is often limited. This report describes the complementary role of ultrafast computed tomography (CT) with 2D echocardiography in the evaluation of coronary artery aneurysms resulting from Kawasaki disease (mucocutaneous lymph node syndrome). Six pediatric patients with coronary aneurysms were examined with 2D echocardiography and ultrafast CT. Ten of 11 lesions were detected with ultrafast CT. The one missed coronary artery aneurysm was one of two contiguous aneurysms. Because of intersection thickness these two discrete aneurysms were interpreted as a solitary aneurysm. Ultrafast CT allowed detection of one aneurysm not initially visualized with echocardiography. In conclusion, ultrafast CT was found to be an effective complementary procedure with 2D echocardiography for noninvasively evaluating coronary artery aneurysms occurring as sequelae of Kawasaki disease.
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