Is it necrotising enterocolitis? Is it focal intestinal perforation? Or is it something else? And does it matter?

Making an accurate distinction between necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) in a preterm infant presenting with obvious abdominal pathology has challenged neonatologists and neonatal surgeons for some time.With significant overlap between the epidemiology, presenting symptoms, clinical signs, radiology, surgical findings, histopathology and even post-mortem findings, it is unsurprising that making an accurate distinction between these disease entities is fraught with difficulty.Indeed according to some published definitions there is significant overlap and using some of these may result in inability to differentiate at all. 1 2 Yet there are reasons why making this distinction is important in our quest to improve both understanding and outcomes.