Internal Hernia Masquerading As Necrotizing Enterocolitis

Abstract

In extremely preterm infants, acute abdominal emergencies are fortunately less common with improving care. Spontaneous intestinal perforation and necrotizing enterocolitis are conditions where emergency surgery is most often needed. Conservative medical management and placement of temporary drain are often used in the initial management. Internal hernia (IH) is an uncommon cause of bowel obstruction in neonates, is difficult to diagnose and unfortunately are found only at autopsy. The presentation in preterm infants, distinction between these conditions, and the need for early diagnosis of IH are discussed.

Keywords: acute abdomen; exploratory laparotomy; extreme preterm infant; internal hernias; necrotizing enterocolitis.

Figure1

Left pane—plain AP radiograph of chest and abdomen with dilated loops of bowel. Central pane—plain left lateral decubitus radiograph of abdomen with dilated bowel loops and no evidence of pneumoperitoneum. Right pane—sequential AP radiograph of abdomen showing fixed dilated “sentinel” loops.