A neonate born at 28 weeks gestation develops abdominal distension, bilious gastric residuals, and blood in stools on day 10 of life. Abdominal X-ray shows pneumatosis intestinalis. Bell stage classification would classify this as:

• A Bell stage II (definite NEC) ✓
• B Bell stage I
• C Bell stage III (advanced NEC)
• D Cannot be staged without portal venous gas

Explanation

Necrotizing enterocolitis is staged by Bell criteria. Stage I is suspected. Stage II is definite NEC with systemic signs plus pneumatosis intestinalis on X-ray. Stage III is advanced with perforation, shock, or DIC. Pneumatosis intestinalis alone without perforation or systemic deterioration places this infant in Bell stage II. Portal venous gas indicates severe disease but is not required for staging.

Reference: Coran's Pediatric Surgery, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.