Bubbles in the heart as first sign of gastric pneumatosis

Abstract

This case report describes a 5-week-old boy with an unusual presentation of gastric pneumatosis caused by suspected necrotizing enterocolitis (NEC) after cardiogenic shock. Postnatally, a pulmonary atresia with intact ventricular septum was supplied by a modified Blalock–Taussig shunt. On transthoracic echocardiography in week 5, primarily performed to rule out pericardial effusion, air bubbles have been apparent in the right atrium. Intracardiac air found on echocardiogram is generally associated with an indwelling venous catheter but—as exemplified by this case report—may also occur in the setting of NEC. An abdominal radiograph showed an isolated gastric pneumatosis, which is an unusual location of NEC. It is speculated that air moved through the connecting veins to the right atrium, the pneumatosis located in the gastric wall being a prerequisite to this pathophysiology. Conclusion: The suspected NEC was located in the stomach enabling the intramural air to pass through connecting veins to the right atrium. The first specific sign of NEC in our case was air bubbles in the right atrium on echocardiography.

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References

  1. 1.

    Abraham B, Sachdeva R, Vyas P, Collins R (2012) An unusual presentation of necrotizing enterocolitis on an echocardiogram. Pediatr Cardiol 33:1427–1429

    PubMed  Article  Google Scholar 

  2. 2.

    Christensen R, Lambert D, Baer V, Gordon P (2013) Necrotizing enterocolitis in term infants. Clin Perinatol 40:69–78

    PubMed  Article  Google Scholar 

  3. 3.

    Duran R, Vatansever U, Aksu B, Acunas B (2006) Gastric pneumatosis intestinalis: an indicator of intestinal perforation in preterm infants with necrotizing enterocolitis? J Pediatr Gastroenterol Nutr 43:539–541

    PubMed  Article  Google Scholar 

  4. 4.

    Fugelseth D, Lindemann R, Liestol K, Kiserud T, Langslet A (1997) Ultrasonographic study of ductus venosus in healthy neonates. Arch Dis Child Fetal Neonatal 77:131–134

    Article  Google Scholar 

  5. 5.

    Kawase Y, Ishii T, Arai H, Uga N (2006) Gastrointestinal perforation in very low-birthweight infants. Pediatr Int 48:599–603

    PubMed  Article  Google Scholar 

  6. 6.

    McElhinney D, Hedrick H, Bush D, Pereira G, Stafford P, Gaynor J, Spray T, Wernovsky G (2000) Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 106:1080–1086

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Morgan J, Young L, McGuire W (2011) Pathogenesis and prevention of necrotizing enterocolitis. Curr Opin Infect Dis 24:183–189

    PubMed  Article  Google Scholar 

  8. 8.

    Springer A, Reck C, Hoermann M, Messerschmidt A, Horcher E, Rebhandl W (2010) Gastric pneumatosis in necrotizing enterocolitis. Klin Padiatr 222:273

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Taylor D, Tung J, Baffa J, Shaffer S, Blecker U (2000) Gastric pneumatosis following cardiac surgery. Eur J Pediatr 159:553–554

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Travadi J, Patole S, Simmer K (2003) Gastric pneumatosis in neonates: revisited. J Paediatr Child Health 39:560–562

    CAS  PubMed  Article  Google Scholar 

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All authors declare no conflict of interest.

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Correspondence to Béatrice Müller.

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Müller, B., Stahr, N., Knirsch, W. et al. Bubbles in the heart as first sign of gastric pneumatosis. Eur J Pediatr 173, 1587–1589 (2014). https://doi.org/10.1007/s00431-013-2129-x

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Keywords

  • Children
  • Necrotizing enterocolitis
  • Gastric pneumatosis
  • Intracardiac air