Radiology Quiz 47589 | Radiopaedia.org

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What is the next best radiographic study to evaluate the patient?

The radiograph mentioned below shows distended large and small bowel. This is suggestive of lower gastrointestinal obstruction. In a pediatric patient with lower gastrointestinal obstruction, an iodinated contrast enema is indicated. Contrast enema gives excellent anatomic detail of the colon and can discern between different etiologies of obstruction, including colonic strictures - a known complication of necrotising enterocolitis.

The patient is managed conservatively and is eventually transferred out the NICU. While on the general pediatrics floor, the patient becomes distended once again and is inconsolable. Repeat abdominal x-ray shows multiple distended loops of large and small bowel.