Valor preditivo da distensão de alças intestinais em radiografias no prognóstico de enterocolite necrosante

Abstract

OBJECTIVE: To evaluate the prognostic value of bowel loops dilatation as a finding on radiographs in the development and mortality of neonates with necrotizing enterocolitis. MATERIALS AND METHODS: On abdominal radiographs of 53 patients for diagnostic suspicion of necrotizing enterocolitis, the major diameters of dilated bowel loops (AD) were measured, as well as the distance between the upper border of the first lumbar vertebra and the lower border of the second one (L1-L2), and the distance between the lateral borders of the first lumbar vertebra (L1) pedicles, and the subsequent association between AD/L1-L2, AD/ L1. This measure was considered as a possible determining factor for potential complications, surgical intervention and mortality. RESULTS: The patients who needed surgical management and who had complications during progression and died of the disease had showed increased AD and AD/L1-L2 (p < 0.05). AD/ L1 values and site of the most dilated bowel loop were not different in the groups with unfavorable progression. CONCLUSION: Bowel loop dilatation detected on initial supine abdominal radiographs suggests a worst prognosis in necrotizing enterocolitis. Furthermore, measurement of the most dilated bowel loop on these radiographs is a simple and reproducible method that adds diagnostic and prognostic information. Keywords: Necrotizing enterocolitis; Radiography; Progression.Valor preditivo da distensão de alças intestinais em radiografias no prognóstico de enterocolite necrosante. OBJETIVO: Avaliar o valor prognóstico da distensão de alças intestinais observada em radiografias na evolução e mortalidade de neonatos com enterocolite necrosante. MATERIAIS E MÉTODOS: Nas radiografias de abdome de 53 pacientes obtidas no momento da suspeita diagnóstica de enterocolite necrosante, foi realizada a medida do diâmetro da alça mais distendida (AD), assim como a distância entre a borda superior da primeira vértebra lombar e a borda inferior da segunda (L1-L2), a distância entre as bordas laterais dos pedículos da primeira vértebra lombar (L1), e foram estabelecidas as associações entre AD/L1-L2 e AD/L1. Esta medida foi considerada como possível determinante de potenciais complicações, intervenção cirúrgica e mortalidade. RESULTADOS: Os pacientes que necessitaram de tratamento cirúrgico, aqueles que tiveram complicações durante a evolução e aqueles que morreram da doença tiveram a relação entre AD e AD/L1-L2 maiores (p < 0,05). Os valores de AD/L1 e a localização da alça mais distendida não foram diferentes nos grupos com evolução desfavorável. CONCLUSÃO: Distensão de alça intestinal detectada em radiografias de abdome realizadas na admissão sugerem pior prognóstico em enterocolite necrosante. Outrossim, medidas do diâmetro da alça mais distendida nessas radiografias são um método simples e reprodutível que oferece informações diagnósticas e prognósticas. Unitermos: Enterocolite necrosante; Radiografia; Evolução. AbstractResumo

Bowel Dilatation on Initial Plane Abdominal Radiography May Help to Assess the Severity of Necrotizing Enterocolitis in Preterm Infants

“…Using these two approaches, we provide further evidence of a positive relationship between the diameter of the most distended bowel loop with the transverse diameter of the first lumbar vertebra and the diameter of the distance of the first two lumbar vertebrae in the prediction of the occurrence of NEC and its severity. However, our results regarding the association of the site of the most distended bowel loop and the severity of the disease did not reach statistical significance, which is in line with the study of Martins et al [7]. The reason for the right iliac fossa as the most common localization (~30%) of the distended bowel loop could be due to the difficulties of collateral circulation in the terminal ileum region [7].…”

“…However, our results regarding the association of the site of the most distended bowel loop and the severity of the disease did not reach statistical significance, which is in line with the study of Martins et al [7]. The reason for the right iliac fossa as the most common localization (~30%) of the distended bowel loop could be due to the difficulties of collateral circulation in the terminal ileum region [7]. Our study has several limitations.…”

“…A similar proposal came from Martins et al, who concluded that measurement of the most dilated bowel loop on initial supine ARs is a simple and reproducible method that adds diagnostic and prognostic information [7]. The authors also showed that bowel dilatation was associated with a worse prognosis in NEC patients [7]. Using these two approaches, we provide further evidence of a positive relationship between the diameter of the most distended bowel loop with the transverse diameter of the first lumbar vertebra and the diameter of the distance of the first two lumbar vertebrae in the prediction of the occurrence of NEC and its severity.…”

“…Edwards also suggested that the previously used subjective description of bowel distension (mild/moderate/severe) should be replaced by numerical values [6]. A similar proposal came from Martins et al, who concluded that measurement of the most dilated bowel loop on initial supine ARs is a simple and reproducible method that adds diagnostic and prognostic information [7]. The authors also showed that bowel dilatation was associated with a worse prognosis in NEC patients [7].…”

“…Only the first abdominal radiographs taken for a patient with suspected necrotizing enterocolitis was re-reviewed for the study purposes. We examined the ratio between the diameter of the most distended intestinal loop (AD) and the diameter of the lateral edges of the first lumbar vertebral body (L1) as previously suggested by Edwards and Martins [6,7] (Figure 2). In addition, we explored the ratio between the upper edge of the first lumbar vertebra and the lower edge of the second one, including the disc space (L1-L2) ( Figure 2).…”