Gastrointestinal Tract Perforation in the Newborn and Child: Imaging Assessment

Specific imaging features of intestinal perforation on supine abdominal X-ray evaluation in infants with necrotizing enterocolitis

Background

Necrotizing enterocolitis (NEC) is associated with high mortality and morbidity in neonates. For infants with NEC, intestinal perforation is the most serious complication, and confirming perforation and performing radical surgical treatment as early as possible may reduce mortality and sequelae. The aim of this study was to identify the specific imaging characteristics of intestinal perforation after NEC on supine abdominal X-ray for the early diagnosis of intestinal perforation.

Methods

A retrospective study was conducted at the Children’s Hospital of Chongqing Medical University. Infants admitted to the hospital from 2013 to 2020 with NEC (Bell’s stage ≥Ⅱ) were divided into perforation and non-perforation groups. All infants were examined by abdominal X-ray in the erect and supine positions. The sensitivity and specificity of specific X-ray signs were analyzed.

Results

A total of 598 infants were included, 113 of whom suffered from perforation. On the supine abdominal films, lucency over the liver shadow, the liver falciform ligament sign, the football sign, the Rigler sign, the triangle sign and more than any one of the above signs had sensitivities of 64.60%, 45.13%, 37.17%, 30.97%, 15.93% and 86.73%, respectively. None of these signs were found on erect or supine abdominal films in the non-perforation group. The total of accuracy of prediction was 46.76%, and the specificity of all the signs was 100%.

Conclusion

Specific signs on supine abdominal X-ray could be used to confirm perforation in neonates with NEC with 86.73% sensitivity and 100% specificity.

Basic Approach to Reading a Radiograph in the Neonate

The radiograph is a cost-effective and minimally invasive testing mechanism used to assist clinicians in the diagnosis of many diseases that affect the newborn. However, radiographic interpretations can differ between radiologists and clinicians. The interpretation of findings is most accurate when considered in the context of the patient's clinical presentation, symptoms, and test results. This column presents readers with a basic approach to reading a radiograph as well as a guide to interpreting both chest and abdominal x-rays.