Pathologic quiz case. Pneumatosis intestinalis in a 6-year-old girl with ulcerative colitis.
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Necrotizing enterocolitis of the small bowel in polyarteritis nodosa is rare. In the proper clinical setting, pneumatosis intestinalis and mesenteric air are characteristic of this entity.
Clinical data and radiographic findings of 32 newborn suffering from necrotising enterocolitis were analysed [12 patients with rotavirus-positive necrotising enterocolitis (RV + NEC), 20 patients with rotavirus-negative necrotising enterocolitis (RV-NEC)]. The presence and degree of pneumatosis intestinalis, portal venous gas and pneumoperitoneum on abdominal radiographs were graded after Kosloske et al. according to "mild, moderate, and severe". Pneumatosis intestinalis occurred twice as often in the ascending colon in RV-NEC compared to RV + NEC, whereas the transverse colon was involved nearly as frequently as the descending colon in both groups. Portal venous gas was present in 10% of the cases with RV-NEC and was absent in RV + NEC. Pneumoperitoneum only occurred in 8% of RV + NEC but in 20% of RV-NEC. Radiographic findings are helpful in the differentiation between both groups of NEC. Conservative therapy is preferable especially in mainly distal colon distribution of pneumatosis intestinalis without pneumoperitoneum.
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