NEC and portal venous gas radiology — distinguishing from deliberate-air injection

A radiology and clinical-context walkthrough of necrotising enterocolitis (NEC) and hepatic portal venous gas in extremely preterm infants. NEC affects 7-10% of <1500g infants with 20-30% mortality, is the leading gastrointestinal emergency in preterm neonates, and is independently associated with hepatic portal venous gas — the imaging finding the Crown attributed to deliberate injection in the Letby NG-tube counts. The piece covers post-mortem gas redistribution as a further confounder and explains why NEC must be the differential of first choice for the imaging picture. Independent paediatric gastroenterology has reached the same conclusion in published commentary on the prosecution's mechanism.