A TERM gestation male infant presented at 48 hours of life with a history of delayed meconium passage and bilious emesis. He was delivered by spontaneous vaginal delivery following an uncomplicated pregnancy. A soft, systolic ejection murmur was noted during the initial physical examination. Chest radiograph, arterial blood gas levels, electrocardiogram, and 4 extremity blood pressures were normal, and the murmur resolved on the second day of life. The patient's medical history was otherwise unremarkable. Results of a physical examination disclosed a slightly distended abdomen and hyperactive bowel sounds. Rectal examination revealed a patent anus with normal sphincter tone. Serum electrolyte and glucose levels were normal. The infant's white blood cell count was 18 x109/L, with 0.03 bands, 0.67 segmented neutrophils, and 0.30 lymphocytes on differential cell count. Abdominal radiographs were obtained (Figure 1 and Figure 2). The patient was treated with intravenous fluids, broad-spectrum systemic antibiotics, and bowel decompression, and was discharged from the hospital at 2 weeks of age with no complications.
Wheeler DS. Radiological Case of the Month. Arch Pediatr Adolesc Med. 1999;153(2):199-200. doi: