E2216. Is it NEC? Diagnostic Challenge in a Term Infant with Hematochezia and Abdominal Distention
  1. Thomas Stirrat; Georgetown University School of Medicine
  2. Daniel Wang; Georgetown University School of Medicine; MedStar Georgetown University Hospital
  3. Earn-Chun Lee; Georgetown University School of Medicine; MedStar Georgetown University Hospital
  4. Arash Zandieh; Georgetown University School of Medicine; MedStar Georgetown University Hospital
This educational exhibit centers on the case of an 8-week-old term infant with a history of jejunal atresia, presenting with abdominal distention, feeding intolerance, and hematochezia following discharge from the NICU. The imaging findings and clinical features overlap between necrotizing enterocolitis (NEC) and food protein-induced enterocolitis syndrome (FPIES), thus creating a diagnostic challenge. This report aims to increase awareness of FPIES in term and preterm infants with atypical presentations and emphasizes the critical role of a thorough evaluation in differentiating NEC from FPIES.

Educational Goals / Teaching Points
Formulate a differential for hematochezia in a pediatric patient. Understand NEC and the imaging manifestations of NEC. Understand clinical features of food protein enterocolitis syndrome (FPIES) and its diagnostic criteria. Recognize the overlapping imaging and clinical features between NEC and FPIES and distinguish among these entities.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In this case, diagnostic imaging was performed utilizing radiography and ultrasound, which revealed dilated bowel loops, pneumatosis intestinalis, and portal venous gas, all of which raised concerns for both NEC and FPIES. These overlapping imaging findings and clinical features between the two conditions represent the main diagnostic challenge in this case. Additional unique pathophysiologic considerations stemming from FPIES correspond with the patient's laboratory data, clinical course, and ultimately may be distinguished by oral food challenge to render definitive diagnosis.

The pediatric patient presenting with hematochezia and abdominal distention presents a diagnostic challenge with multiple possible causes. Diagnostic imaging plays a role in the clinical workup. Both NEC and FPIES can present with dilated bowel loops, ileus, pneumatosis, and portal venous gas, but have dramatically different management/treatment and prognosis. This case underscores the need for accurate diagnosis and understanding of the implications for optimal clinical practice.