The ultrasound features of necrotic bowel in children: A pictorial essay

Eu Leong Harvey Teo, Diagnostic Imaging and Intervention KK Women’s and Children’s Hospital, Singapore


Bowel necrosis (BN) is death of part of the intestines due to its blood supply being cut off.  Although patients are invariably septic and very ill, it is a difficult diagnosis to make clinically.  Ultrasound is a relatively inexpensive, portable and readily available modality that is useful in the diagnosis of BN. This pictorial essay will illustrate the ultrasound features of BN and highlight some of the causes in children. Correlation with plain radiographs, CT and pathological specimens will be shown.

Imaging Findings

Necrotising enterocolitis, malrotation with small bowel volvulus and incarcerated inguinal hernias are common causes of BN in the neonatal period. Intussusception, complications of Meckel’s diverticulum, post-surgical adhesions, internal hernias and vasculitic causes are more common in older children.

The ultrasound features of BN include persistent dilated loops of thick-walled bowel, intramural gas appearing as echogenic specks, bubbles of gas within the portal vein, absent intra-mural colour Doppler signs and pneumoperitoneum. The diagnosis of BN can be made earlier on ultrasound than on abdominal radiographs. 


This pictorial essay will familiarize the reader with a wide range of conditions that may cause BN in children. The reader will also learn to recognize the imaging features of BN on various imaging modalities with an emphasis on ultrasound. Knowledge of these findings will help the Radiologist diagnose the condition early possibly preventing severe complications later on.

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