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Demo Question

You are called to see a newborn girl on the postnatal ward. She was a FTND weighing 2.99kg and no resuscitation was required. After arriving in the postnatal ward she was noted to have a distended abdomen. After mother tried to feed her, she vomited milk and saliva. She has passed a tiny amount of inspissated meconium.

On examination she has generalised abdominal distension with visible bowel loops, which feel cord-like, with active bowel sounds. Cardiac and respiratory examinations are normal. Abdominal X-ray shows variably distended loops of bowel unevenly filled with gas.

What is the most likely diagnosis?

  Hirschprung disease

  Jejunal atresia

  Meconium ileus 

  Duodenal atresia

  Necrotising enterocolitis

Key learning points

 

Know the presentations of cystic fibrosis and the principles of treatment.

Explanation

 

The clinical picture is of intestinal obstruction, with solid bowel loops, and the passage of inspissated meconium. The abdominal X-ray is characteristic of meconium ileus, with variable degrees of distension of bowel loops and uneven distribution of gas due to cystic fibrosis.

Sometimes, there may be a family history.

In Hirschprung disease there is the passage of toothpaste-like stool from a tight anal sphincter after digital rectal examination.

Duodenal atresia gives a double bubble sign on abdominal X-day, and jejunal atresia multiple bubbles.

Necrotising enterocolitis usually affects premature infants.

[FResE7] Know the presentations of cystic fibrosis and the principles of treatment

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