A premature neonate at 29 weeks gestation develops abdominal distension and bloody stools on day 10. Abdominal X-ray shows intramural gas (pneumatosis intestinalis) in the right lower quadrant. The pathognomonic radiological sign of the most severe complication of this condition is:

• A Pneumoperitoneum ✓
• B Fixed dilated loop of bowel
• C Portal venous gas
• D Gasless abdomen

Explanation

Necrotising enterocolitis (NEC) is the diagnosis. The most severe complication is intestinal perforation, manifested by pneumoperitoneum (free intraperitoneal air) on X-ray, indicating the need for urgent surgical intervention. Portal venous gas (gas in the portal venous system) is a grave sign but indicates severe NEC rather than perforation specifically. A fixed loop suggests ischaemic or necrotic bowel, and a gasless abdomen suggests extensive ileus or early NEC.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.