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  • Imaging Casebook
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Imaging Case Book

Neonatal necrotizing gastritis; hypoplastic left heart

Journal of Perinatology volume 28, pages 843–845 (2008)Cite this article

The autopsy confirmed hypoplastic left heart with a markedly hypoplastic ascending aorta and ventricular septal defect with double outlet left ventricle. The autopsy further revealed gastric necrosis with pneumatosis with mural edema and hemorrhage extending from the gastric mucosa to the muscular propria. Hypoplastic left heart and its variants, univentricular heart and univentricular heart with aortic arch obstruction, are associated with increased risk of necrotizing enterocolitis (NEC).1, 2 The incidence of NEC in infants with hypoplastic left heart is approximately 8%.1, 2 However, neonatal necrotizing gastritis is rare compared with NEC.3, 4

Gastric pneumatosis can be separated into gastric emphysema and necrotizing gastritis or emphysematous gastritis.5 Gastric emphysema is usually due to a relatively benign etiology, often associated with elevated gastric pressures. Etiologies include pyloric stenosis, duodenal atresia, phytobezoar and complications of gastric intubation. The air in the stomach wall is characteristically cystic in these patients. Emphysematous gastritis is associated with sepsis, asphyxia, child abuse, cardiac malformation and cardiac surgery. In these patients, the intramural air is more often bubbly or linear in appearance. The differentiation between gastric emphysema due to obstruction and emphysematous gastritis is usually based on the clinical condition of the patient.5

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References

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Authors and Affiliations

  1. St Louis Children's Hospital Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA

    T E Herman & M J Siegel

  2. Division of Neonatology, Elizabeth Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA

    A Vachharajani

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  1. T E Herman
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  2. A Vachharajani
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  3. M J Siegel
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Correspondence to T E Herman.

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Herman, T., Vachharajani, A. & Siegel, M. Neonatal necrotizing gastritis; hypoplastic left heart. J Perinatol 28, 843–845 (2008). https://doi.org/10.1038/jp.2008.86

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