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A low-birth-weight neonate, who passed meconium on the first day of life, is started on formula at 2 days of age. The infant develops abdominal distension and tenderness, accompanied by findings suggestive of sepis, including hypotension and neutrophilia of the blood. What is most likely to be seen at emergency surgery?
Options:
A. A massive thickening of the pylorus.
B. A massively dilated colon.
C. Bowel loops in the chest cavity.
D. Gangrene of the terminal ileum and ascending colon.
E. Normal-appearing gastrointestinal tract.
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The correct answer is D. The infant has necrotizing enterocolitis, which can affect infants any time in the first few months of life, but is most common around the time an infant is started on oral foods. The functional immaturity of the neonatal gut apparently leaves it particularly vulnerable to a combination of ischemic injury and colonization by pathogenic organisms. Formula-fed infants appear to be more vulnerable than breast-fed infants, possibly due to the absence of maternal antibodies or other immunoprotective features in formula. Premature and low-birth-weight infants are also more likely to develop this condition. Affected infants may have either mild gastrointestinal illness or develop frank, life-threatening gangrene of the terminal ileum and ascending colon.
Thickening of the pylorus (choice A) is a feature of congenital hypertrophic pyloric stenosis, which
typically presents with vomiting and regurgitation in an older infant.
A massively dilated colon (choice B) suggests Hirschsprung's disease, which may present in a similar
fashion to necrotizing enterocolitis. The two conditions can usually be distinguished by noting that meconium is usually not passed prior to feeding of the neonate in Hirschsprung's disease.
Bowel loops in the chest cavity (choice C) are a feature of congenital diaphragmatic hernia, which
causes respiratory distress and, often, death in neonates.
The gastrointestinal tract would be unlikely to appear normal (choice E) in a case such as this.
