Presentation
Preterm (28/40) neonate with RDS. Abdominal distension. Not responding well to being handled.
Patient Data
NG tube, bladder catheter and right femoral line - positions appropriate.
Widespread gas-filled loops of bowel. No mural, free or portal-venous gas.
Very similar bowel gas pattern, concerning for NEC as suspected clinically. Mottling on the right side. No free, mural or portal-venous gas.
There is now clear evidence of free gas within the abdomen and Rigler sign centrally. On the lateral decubitus film, the volume of free gas is clearly demonstrated.
Case Discussion
Appearances of necrotizing enterocolitis (NEC) with associated perforation. Perforation is important to recognize and report because it will result in the reorientation of treatment from medical (antibiotics and resting the bowel) to surgical.