A 2-week-old premature neonate develops abdominal distension and bloody stools. Abdominal X-ray shows pneumatosis intestinalis and portal venous gas. Which radiographic finding would be an absolute indication for surgical intervention?
- A Pneumatosis intestinalis alone
- B Pneumoperitoneum ✓
- C Fixed dilated loop on serial radiographs
- D Portal venous gas alone
Correct answer: B. Pneumoperitoneum
Explanation
Pneumoperitoneum (free intraperitoneal air) in the context of NEC indicates intestinal perforation and is an absolute indication for surgical intervention. Pneumatosis intestinalis (gas in the bowel wall) is diagnostic of NEC but can be managed medically. Portal venous gas has been traditionally considered ominous but alone does not mandate surgery. A fixed dilated loop is concerning but represents a relative indication, prompting close monitoring or laparotomy based on clinical status.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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