Early necrotizing enterocolitis in a 2-day-old term neonate: A case report

Necrotizing enterocolitis (NEC) remains one of the most devastating and poorly understood intestinal diseases in neonates. A 30-h-old male neonate was born at a gestational age (GA) of 39 weeks and 3 days, weighing 2800 g, with APGAR scores of 7 and 8 at one and 5 min, respectively. After delivery, the baby began breastfeeding and passed meconium within 16 hours, but developed bilious vomiting, abdominal distension, and dark-red rectal bleeding at 24 hours of age. Palpation of the abdomen elicited a crying response from the infant, and Per rectal exam showed blood on the examining catheter. The white blood cell count was 10.25 × 10^9/L, with a neutrophil percentage of 78.6 %. Abdominal imaging was not conducted due to logistical reasons. Given the clinical presentation, a diagnosis of intestinal malrotation with acute midgut volvulus and potential ischemia was made. The infant underwent laparotomy, revealing necrosis of the transverse and descending colon, which was excised, and the ascending colon was anastomosed to the sigmoid colon. A biopsy of the necrotic colon was consistent with necrotizing enterocolitis, revealing coagulative necrosis and pneumatosis cystoides intestinalis. Postoperatively, the infant had a nasogastric tube for five days, progressed to full feeding over a week, and was discharged on day 14, thriving at eight months post-operation. Necrotizing enterocolitis must be included in the differential diagnosis of term neonates who develop bilious emesis, abdominal distension, and bloody stool.