Incidental Detection of Portal Venous Gas During POCUS in a Neonate With Necrotizing Enterocolitis and Intestinal Perforation: A Case Report

In a postoperative cardiac neonate undergoing bedside hemodynamic assessment for suspected venous congestion, point-of-care ultrasound performed by a pediatric intensivist unexpectedly revealed hepatic portal venous gas. This finding prompted immediate abdominal reassessment and urgent radiography, which demonstrated pneumoperitoneum. Exploratory laparotomy revealed terminal ileal perforations with ischemic changes and fecal peritonitis. Although the examination was performed for hemodynamic purposes, careful assessment of the portal venous system disclosed a clinically important abnormality unrelated to congestion. This case highlights the importance of recognizing sonographic signs suggestive of necrotizing enterocolitis and intestinal perforation during bedside POCUS to facilitate timely diagnostic escalation.