Colonic: pneumatosis intestinalis in preterm infants: different to necrotising enterocolitis with a more benign course?

Necrotising enterocolitis (NEC) is the predominant immaturity-associated di sease of the bowel in the preterm neonate and leads to substantial mortalit y and long-term morbidity. Diagnostic features of NEC include, apart from t he clinical presentation, laboratory and radiological parameters. Pneumatos is intestinalis (PI) on abdominal radiographs is regarded as a criterion of definitive proof for this disease entity. The objective of this presentati on is to link the topographic pattern of PI to the clinical course in cases of suspected NEC. We report two cases of radiological appearance of coloni c PI indicative of NEC without associated laboratory and/or macroscopic evi dence of the disease, and with minor clinical symptoms only. Data from anim al studies indicate that decreased blood supply to the small bowel is assoc iated with more extensive bowel damage as compared to impaired colonic perf usion. Therefore the topographical distribution of PI might be a more speci fic sign as the general presence or absence of PI. Conclusion The topographical pattern of pneumatosis intestinalis may be pre dictive of the clinical course of inflammatory bowel disease in preterm inf ants.