A 3-day-old neonate develops bilious vomiting, abdominal distension, and bloody stools. Abdominal X-ray shows pneumatosis intestinalis. What is the MOST likely diagnosis?

• A Necrotizing enterocolitis ✓
• B Hirschsprung disease
• C Meconium ileus
• D Duodenal atresia

Explanation

Necrotizing enterocolitis (NEC) classically presents in preterm or stressed neonates with abdominal distension, bloody stools, and pneumatosis intestinalis (gas in the bowel wall) on X-ray, which is pathognomonic. Bilious vomiting reflects ileus. Management includes bowel rest, IV antibiotics, and surgical intervention for perforation or clinical deterioration. Hirschsprung disease presents with delayed meconium passage; meconium ileus is associated with cystic fibrosis.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.