Presentation
Abdominal distension, black vomit, mucoid stool for two days. To rule out intestinal obstruction, necrotizing enterocolitis or sepsis.
Patient Data
Aperistaltic diffusely air-fluid dilatation of the small bowel loops (measuring up to 2.7 cm in diameter). Minimal intraperitoneal fluid is noted intervening between the thickened adjacent bowel wall structures. There is moderate colonic gaseous distension. Mild left-sided renal pelviectasis. The rest of the abdominal viscera is grossly normal.
Gas-filled hugely dilated bowel loops centrally (inverse flowerpot sign) with multiple crescentic intraluminal lucencies typical of the soap bubbles appearances accompanied with thickened bowel wall.
Case Discussion
Post-operative findings revealed type 1 ileal atresia, internal hernia, and necrosis at the ileo-jejunal junction as the primary cause of intestinal obstruction in this presentation. The ultrasound findings show aperistaltic bowel loops with air-fluid distension with the cocooned bowel loops surrounding the central abdomen.
Supine abdominal x-ray added value by showing diffuse gaseous distension of the proximal abdominal bowel loops characterized with bubbly/curvilinear intramural lucencies (pneumatosis intestinalis) plus thickened bowel walls (Rigler's sign) suggestive of grade 1 necrotizing enterocolitis (NEC).
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