Contrast enema in suspected post-NEC intestinal strictures without direct stenosis signs: a retrospective study of 191 surgically confirmed cases

Objective: Contrast enema (CE) is widely used for suspected post-NEC intestinal strictures, yet some surgically confirmed strictures show no direct stenosis on CE. We aimed to characterize clinical and CE findings in these cases and identify features associated with multi-segment involvement to inform preoperative management. Methods: We retrospectively reviewed 191 infants with surgically confirmed post-NEC intestinal strictures who underwent preoperative CE. Infants were classified as CE-positive (direct stenosis on CE) or CE-negative (no direct stenosis). Based on intraoperative findings, strictures were further categorized as single-segment or multi-segment. Clinical characteristics and radiographic signs were compared between groups. Results: < 0.001). Conclusion: In surgically confirmed post-NEC strictures without direct stenosis on CE, infants are more often premature with lower birth weight, and lesions tend to involve the ileum and right colon. Indirect CE signs such as small-bowel dilatation and microcolon may support clinical decision-making in CE-negative cases, and bead-like/sausage-like appearance suggests a high likelihood of multi-segment involvement.