Gastric pneumatosis in a preterm infant

1808 www.thelancet.com Vol 366 November 19, 2005 A baby boy at 32 weeks’ gestation was born by spontaneous onset of preterm labour. He weighed 2265 g and had Apgar scores of 7 at 1 min and 9 at 5 min. He was clinically stable for 3 days and was started on enteral feeds. On the fourth day, we noted that he had temperature instability and abdominal distension with sanguineous gastric aspirates. He had poor perfusion, lactic acidaemia, and hyperglycaemia, and needed intubation and fluid resuscitation. Abdominal radiographs showed gastric and intestinal pneumatosis without any evidence of free intraperitoneal or portal venous air (figure). Leucopenia, neutropenia, and thrombocytopenia were also present, and we started the boy on antibiotics after blood culture. Because no organism was isolated, we did not do a laparotomy. He improved over the next month but became intolerant to the enteral feeds. We did a contrast study, which showed small bowel obstruction. At laparotomy we found several old small bowel perforations with associated strictures, and resected two small ileal segments. His stomach and duodenum did not show any abnormality. Histopathology was consistent with necrotising enterocolitis with perforation, and a rectal biopsy showed submucosal ganglia with normal cholinesterase pattern. Although necrotising enterocolitis is common in babies in neonatal intensive care, gastric pneumatosis is rare and usually follows cardiac surgery, pyloric or duodenal stenosis, or intramural misplacement of a feeding catheter. Gastric pneumatosis in a preterm infant