A New born child presented with distended abdomen with bilateral gas under diaphragm. Most likely cause is
|A||Perforation of stomach|
|B||Necrotizing enterocolitis/pneumatosis cystosis intestinalis|
a. Necrotizing enterocolitis is a disease characterized by crepitant necrosis of the gut and is the most common surgical emergency affecting neonatal gut, occurring particularly in premature newborns.
b. A multifactorial etiology is likely.
c. Immaturity of the gut and immune system, formula feeds (breast milk is protective), bacterial infection and impaired gut blood flow have been implicated.
d. The baby typically develops abdominal distension, bloody stools and bilious aspirates, and rapidly deteriorates.
e. Patchy or extensive pneumatosis intestinalis progresses to necrosis and perforation of the gut–gas under diaphragm.
f. Milder cases of necrotizing enterocolitis respond to antibiotics, gut rest and delayed reintroduction of feeds. However, perforated necrotizing enterocolitis requires resection/ excision of perforated segment followed by temporary stoma or primary anastomosis.