A female baby, second of twin (dizygotic twins), born by emergency cesarean section at 31 + 2 weeks of gestation for premature prolonged rupture of membrane. There was no history of asphyxia or dysmorphism. Trophic feeds were initiated within 1 h of birth and were increased by 10 ml/kg/day. On day 6 of life, the baby had yellowish aspirates and was lethargic. The baby was kept nil per oral. Abdominal X-ray showed air in stomach wall [Figures 1 and 2], suggestive of gastric pneumatosis. The baby was managed conservatively as per standard unit protocol. The septic screen was positive (white blood cell 3190/Cmm, platelets 199,000/Cmm, C-reactive protein 40.4 mg/L, and blood culture was sterile). Antibiotics were started. Pneumatosis resolved within 24 h. Feeds were restarted 7 days after. Baby tolerated feeds well and was discharged.
Figure 1.
X-ray abdomen anteroposterior view - linear gas in stomach wall suggestive of gastric pneumatosis
Figure 2.
X-ray abdomen lateral view - linear gas in stomach wall suggestive of gastric pneumatosis
Pneumatosis, defined as gas within intestinal wall, can occur anywhere in the gastrointestinal tract.[1] Isolated gastric pneumatosis is rare and may be associated with fulminant necrotizing enterocolitis (NEC).[2] It is associated with NEC or proximal intestinal obstruction.[2] In the present case, associated clinical findings are suggestive of NEC. Prematurity seems to be the risk factor. The present case had nonobstructive isolated gastric pneumatosis which responded to conservative treatment. This case illustrates that isolated gastric pneumatosis can be the presenting feature of NEC and if diagnosed early and managed aggressively may have benign course.
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REFERENCES
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