Ultrasound changes in bowel wall thickness and perfusion in necrotizing enterocolitis in newborns

The sequence of color Doppler sonograms (bottom) demonstrating increasing severity of necrotizing enterocolitis is accompanied by simplified diagrams of a transverse section of a bowel loop (top) demonstrating perfusion and bowel wall thickness. The authors believe that progression from the phase of bowel wall thickening and hyperemia (B) to bowel wall thinning and absent perfusion (E) may take a variable time in different patients. However, it may be an extremely rapid process, and the latter findings may indeed be present on abdominal sonograms at presentation.
(A) There is normal flow to normal bowel. The diagram shows normal bowel wall thickness and perfusion.
(B) The changes of NEC are shown with bowel wall thickening and hyperemia.
(C) The bowel wall thickening persists, but the perfusion has diminished.
(D) As the process progresses in more severely affected neonates, the mucosa starts to slough, and the bowel wall becomes much thinner, although some perfusion persists.
(E) Sloughing continues, the bowel wall becomes asymmetrically thinned, and blood flow ceases.