A 3-Week-Old Boy in the Neonatal Intensive Care Unit Has

A 3-week-old boy in the neonatal intensive care unit has several episodes of vomiting.  The vomiting developed 6 hours ago and is bilious but nonbloody.  The patient was born at 28 weeks gestation by vaginal delivery due to cervical insufficiency.  Birth weight was 900 g (2 lb) .  The patient initially required mechanical ventilation but was extubated to oxygen via nasal cannula last week.  He has advanced on continuous nasogastric formula feeds and has gained appropriate weight daily.  The infant has had small, yellow, seedy stools but no bowel movement for the past 24 hours.  Temperature is 35.6 C (96 F) , blood pressure is 75/45 mm Hg, pulse is 165/min, and respirations are 70/min.  Pulse oximetry is 97% on 2 L oxygen.  Examination shows a lethargic neonate.  The abdomen is tense and distended with hypoactive bowel sounds.  Laboratory results indicate leukocytosis and metabolic acidosis.  Which of the following imaging findings would most likely be seen in this patient?

A) Abdominal ultrasound with thickened pylorus muscle
B) Abdominal x-ray with air in the bowel wall and portal veins
C) Abdominal x-ray with air in the stomach and duodenum but no distal air
D) Contrast enema with narrow rectosigmoid and dilation of the rest of the colon
E) Head ultrasound with hemorrhage into the lateral ventricles

Correct Answer:

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