3rd post natal day baby had incessant cry and not take good feeds here is the case x Ray pictures



Pneumoperitoneum...Needs urgent exploration after resuscitation. ...look for anal opening and history of passage of meconium. ..If analysis opening present cause could be H.D or Intestinal atresia for a term baby and possibility of NEC in a preterm low birth weight baby...Any of d condition needs surgical exploration for pneumoperitoneum. ..If ARM repair d site along with a proximal stoma, Atresia stoma ( Bishop koop, Santullis)or R& A as per d intra op picture, H.D if transition zone seen a proximal stoma along with rectosigmoid, transition zone and stoma site biopsy...NEC stoma Or R & A or second look laparotomy depending on condition of bowel

Very interesting x ray...History very short 3rd day Newborn..except incessant cry and feeding avoidance?..baby’s exam VS and particularly abdominal exam.. Any peritonitis signs...Bowel sounds? Lateral abdominal x ray outrightly looks like free air around liver...as though air hepatogram But on AP view Lots of distended bowel loops Initially thought of perforation and lieu’s... But thought of chiladaitis syndrome crossed my mind...Which is usually a symptomatic/benign condition... Here without proper history and no luxury of exam findings ...just on X-ray ...I seriously Evaluate for Gut perforation... even though to me there is no classical foot ball sign Or Cupola sign ...I do think there is NG tube in situ...whether to feed (I guess not)/or decompress the gut...NG tube trauma/perforation I strongly doubt it...Any way History/examination is basic foundation Imaging is only supportive..Only Imaging will not sufficient for prudent approach... I don’t see conclusive answer...Would you mind teaching us something what caused this in 3 day baby presenting with uncosable cry and ? Feeding avoidance..Thanks

check for anal opening-anal atresia distended abdo showing intestinal- large bowel obstruction?

Necrotizing enterocolitis

Any h/o septicemia in mother?

distended abdomen,xr suggestive of volvulus,needs Ped sx intervention and decompression.

Volvulus, malrotation of gut, large gut obstruction strong differentials. H/o passage of meconium , anal Artesia n further more nature of vomitus bilious or nonbilious r important. history very important in tis scenario

ma'am I feel this is a case of acute intestinal obstruction most common being duodenal and ileal atresia. multiple air fluid levels is characteristic of this condition. surgical opinion is very important and maintenance treatment for caloric and fluid intake is must.


I agree with Dr. vinod, bowel is distended, there must be some obstruction. Do an ultrasound for peristalsis and bowel measurements if anal opening is present and patent.

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