The 4-week-old neonate in the neonatal intensive care unit was born at 29 weeks gestation. The patient is stable on room air and has been tolerating nasogastric feedings of expressed breast milk. Generally an active and responsive patient, the nurse notes the patient is lethargic and does not react to his diaper change. Additionally, the patient’s heart rate is 194 bpm, respiratory rate is 82 breaths per minute, and the blood pressure is 54/21 mm Hg. The patient’s abdomen is distended and discolored; dark green emesis is noted as well. An abdominal x-ray is ordered and performed. Which x-ray findings are consistent with the patient’s clinical picture? Select all that apply.

Question

The 4-week-old neonate in the neonatal intensive care unit was born at 29 weeks gestation. The patient is stable on room air and has been tolerating nasogastric feedings of expressed breast milk. Generally an active and responsive patient, the nurse notes the patient is lethargic and does not react to his diaper change. Additionally, the patient&rsquo;s heart rate is 194 bpm, respiratory rate is 82 breaths per minute, and the blood pressure is 54/21 mm Hg. The patient&rsquo;s abdomen is distended and discolored; dark green emesis is noted as well. An abdominal x-ray is ordered and performed. Which x-ray findings are consistent with the patient&rsquo;s clinical picture? Select all that apply.

Accepted Answer

Paucity of bowel gas, Air in the bowel wall , Thickened bowel wall , Small air bubbles overlying the liver , Free air between the diaphragm and the liver. The patient&rsquo;s symptoms are consistent with necrotizing enterocolitis with possible intestinal perforation. It is possible to have one, some, or all of the listed x-ray findings: paucity of bowel gas, air in the bowel wall pneumatosis), thickened bowel wall, small air bubbles overlying the liver (portal venous gas), and free air between the diaphragm and the liver (indicates a bowel perforation).

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