Clinical Presentation

A premature patient in the neonatal intensive care unit with gastric retention of feedings, abdominal distension, tachycardia, and tachypnea.

(A,B) Frontal and left lateral decubitus abdominal radiographs demonstrate a markedly abnormal pattern of bowel gas, with multiple segments of distended bowel and bubbly and linear lucencies most prominent on the right side (arrows). There is no evidence of pneumoperitoneum.

Differential Diagnosis

• Necrotizing enterocolitis (NEC): The bubbly and linear lucencies superimposed over the bowel gas are typical for pneumatosis intestinalis, a nearly diagnostic sign in this clinical setting.

• Bowel obstruction: