Portal Venous Gas in Necrotizing Enterocolitis: Association with Disease Severity and Clinical Outcomes

Background: Portal venous gas (PVG) is a recognized radiologic finding in necrotizing enterocolitis (NEC), but its value as a prognostic marker and indicator for surgical intervention remains controversial. Methods: This retrospective study analyzed data from infants with Bell stage II/III NEC admitted to “G. Salesi” Children’s Hospital NICU between 2013 and 2023. Patients were grouped by presence or absence of PVG on abdominal X-rays at diagnosis. Results: Among 57 infants, 25 (44%) had PVG. Gestational age and birth weight were comparable between groups. Bell stage III NEC was more frequent in PVG infants (64% vs 34%, P = 0.026). Surgery was performed in 56% of cases, more often in PVG patients (72% vs 44%, P = 0.033), who also had longer bowel resections (P = 0.039). Mortality was higher in the PVG group (32% vs 13%), with a significant difference in non-operated infants (43% vs 6%, P = 0.022). Postoperative short bowel syndrome was more frequent with PVG (22% vs 7%). Multivariate analysis identified Bell stage III NEC, not PVG, as significantly associated with surgery and mortality (P = 0.001). Conclusion: PVG in NEC is associated with more severe disease, higher surgical rates, and extensive intestinal resection.