Necrotizing enterocolitis

Discussion:

The x-ray demonstrates multiple dilated loops of bowel without convincing intraperitoneal or portal gas. Intramural gas can however been seen laterally in both flanks.

Ultrasound confirms not only intramural gas (echogenic bowel wall with dirty-shadowing) but also demonstrated portal venous gas as multiple, sometimes branching regions of echogenicity within the liver, again with shadowing. 

Features are consistent with necrotizing enterocolitis.

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