Necrotising Enterocolitis and the Neonatal Surgical Abdomen

What this deck covers

Necrotising Enterocolitis and the Neonatal Surgical Abdomen in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. Day ten, and the feeds stop going down
2. Branching shadows over the liver
3. The film that ends the medical treatment
4. Term, and it still happened
5. Day three, and no pneumatosis at all
6. No meconium by forty-eight hours
7. Bilious from the first feed
8. Bowel on the outside at delivery
9. What actually prevents it
10. Ten days later, and when to feed again
11. Six weeks after he got better
12. Twenty-five centimetres left

What this deck teaches

• The abdominal film does the deciding. Feed intolerance is common and necrotising enterocolitis is not. Gas in the wall makes the diagnosis, gas in the liver marks extensive disease, and gas outside the bowel means theatre.
• Pneumatosis is gas IN the wall, not in the lumen. A bubbly lucency following the contour of the bowel wall is the finding the diagnosis rests on, and what separates this from a bellyful of dilated loops.
• Portal gas reaches the edge of the liver. Biliary gas branches too, but stays central. The peripheral branches are the ones that matter, and the easiest thing on the film to miss.
• Free gas is the only absolute indication to operate. A fixed dilated loop, wall erythema or deterioration despite full medical treatment are conversations with the surgeon, not instructions.
• In a TERM baby it is a symptom, so look at the heart. At term it is uncommon enough to demand a cause for the mesenteric hypoperfusion, and a duct-dependent lesion is the classic one. Feel the femoral pulses.
• Free gas with no pneumatosis in an unfed baby is a spontaneous perforation. First week, usually before feeding starts, associated with indometacin – and a better outlook, so the distinction changes what the parents are told.

Exam pearls from this deck

• Gas in the wall of the bowel is not gas in the bowel. Pneumatosis makes the diagnosis.
• Portal gas runs to the edge of the liver. Biliary gas stays central.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all gastroenterology illustrated case decks · gastroenterology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.