SYB 3General Radiology

An Dang DoMarch 5, 2008

79 yo WM

POD #8, cystectomy; acute onset of severe abdominal pain;(recently received chemotherapy treatments for urothelial cancer)

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Necrotizing Enterocolitis

-one of the more concerning causes of portal venous gas-most common in immunosuppressed patients-necrosis of various layers of bowel walls, almost always cecum (typhlitis)

Contributing factors:mucosal injuryprofound neutropeniaimpaired host defense

Microbes involved:Gram(-) rods; Gram (+) cocci; anaerobes; Candida sp.

Signs and symptoms:ANC < 500/microLfever, abdominal pain/distension, N/V, watery/bloody diarrhea

Song L-M WK, Marcon NE. Necrotizing enterocolitis (typhlitis) in adults. UpToDate. Version 15.3. Accessed March 4, 2008.

Song L-M WK, Marcon NE. Necrotizing enterocolitis (typhlitis) in adults. UpToDate. Version 15.3. Accessed March 4, 2008.

Necrotizing Enterocolitis - Management

Iatrogenic Complication

CXR taken after placement of left subclavian line

Lines and Tubes

Portal venous gas

Free air in abdomen

Distended stomach

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Although findings of portal venous gas, thickened proximal jejunal wall, pneumatosis and pneumoperitoneal were seen on CT and prompted concerns for necrotizing enterocolitis, two exploratory laparotomy procedures did not show any ischemic bowels or perforation.

Iatrogenic Complication

Left pneumothorax

Lines and Tubes

Mediport

NG tube

ET tube

Keofeed tube

Chest tube

Swan-Ganz catheter