Presentation
26/40 neonate. Initially required ventilatory support, but has been well for 10 days (no imaging). New desaturations and abdominal distension.
Patient Data
Widespread gaseous distension of bowel. Mottled appearance right flank. While there is a large loop of bowel descending into the pelvis there is collapsed large bowel in the right flank and this is therefore likely small bowel.
Appearances of distal small bowel obstruction in a 1 month old early-preterm.
Further gaseous distension. Distal small bowel obstruction seem most likely.
No significant improvement. Persistent bowel obstruction.
Diagnostic/therapeutic laparotomy performed. Milk-curd obstruction confirmed. Small bowel decompressed and ileostomy formed.
Right sided ileostomy. Marked improvement in the gas-pattern. No gas-filled distended loops of bowel.
Case Discussion
While, gaseous distension in a preterm neonate may be secondary to necrotizing enterocolitis, it would be unusual for a 1 month old preterm who had been well to develop NEC. Milk curd obstruction occurs when milk-based feeds are introduced and result from condensation of milk curds in the small bowel that stick together to form lumps and induce obstruction.
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