A three-week-old preterm female infant, cared for in the intensive care nursery, presented with abdominal distension. She was born at 31 weeks of gestation by a caesarean delivery and weighed 1330 grams. She had no major problems and received no respiratory support or supplemental oxygen. She underwent a sepsis work-up and received antibiotics for 10 days. She was started on total parenteral nutrition that was discontinued at the age of 2 weeks when she was fed fortified maternal milk exclusively. She had a few short episodes of apnea and mild physiologic hyperbilirubinemia that was treated with phototherapy. She was given aminophylline and vitamin D. Suddenly, at the age of 3 weeks, she presented with abdominal distension, with no vomiting and no gastric bilious residue. Stools were negative for occult blood. She did not appear septic or in a state of shock. Preliminary studies and a plain radiograph of the abdomen were taken. The film was immediately available (Figure 1).
Figure 1.
Plain abdominal radiograph.
What is the abnormal finding on this plain abdominal radiograph?
What is the next step to confirm the diagnosis?
What is the proper treatment and how soon should it be instituted?
Answers on page 249