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Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 1686186210.5144/0256-4947.2006.242asm-3-242What’s Your Diagnosis?A three-week-old preterm female infant with abdominal distension Mounla Nabil From the Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon.Correspondence and reprint requests: Nabil Mounla, MD, MPH, Clinical Lecturer, Neonatologist, Department of Pediatrics, American University of Beirut, Medical Center, P.O. Box 11-0236 Riad-el-Solh, Beirut 1107-2020, Lebanon, Tel: +961-1-374 374/350 000 ext: 5500, Fax: +961-1-370 781/744 464, peds@aub.edu.lbMay-Jun 2006 26 3 242 242 Copyright © 2006, Annals of Saudi Medicine2006This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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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).

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

Figure 1 Plain abdominal radiograph.