Neonatal Gastrointestinal Obstruction, Malrotation, and Necrotising Enterocolitis — WACS Viva & Clinical Scenarios (Paediatric Radiology)
Exam-style neonatal gastrointestinal obstruction, malrotation, and necrotising enterocolitis viva scenarios with examiner probes and model answers for…
Scenarios covered
- SCENARIO 1: A 3-day-old full-term neonate presents with sudden onset of persistent bilious vomiting and irritability. Discuss the emergency imaging algorithm, step-by-step fluoroscopic technique for an upper gastrointestinal contrast study, normal anatomical landmarks of the duodenojejunal flexure, and diagnostic findings of midgut malrotation with volvulus.
- SCENARIO 2: Review a supine and horizontal beam abdominal radiograph of a premature infant born at 31 weeks gestation presenting with abdominal distension, feeding intolerance, and bloody stools. Detail the systematic radiological evaluation for necrotising enterocolitis, differentiate portal venous gas from biliary gas, and outline the radiographic indicators of intestinal gangrene and perforation.
- SCENARIO 3: A 2-day-old infant with Down syndrome presents with epigastric fullness and non-bilious vomiting shortly after birth. Evaluate the plain abdominal radiograph demonstrating the double-bubble sign, discuss differential diagnoses for proximal duodenal obstruction, and identify associated congenital anomalies requiring radiological screening.
- SCENARIO 4: A 4-week-old male infant presents with non-bilious, projectile vomiting and dehydration. Formulate the radiological evaluation strategy, describe the high-resolution transabdominal ultrasound technique, state the diagnostic quantitative criteria for infantile hypertrophic pyloric stenosis, and identify false-positive or false-negative pitfalls.
- SCENARIO 5: A full-term neonate fails to pass meconium within the first 48 hours of life and develops progressive abdominal distension. Describe the diagnostic approach to low intestinal obstruction, contrasting the fluoroscopic and radiographic findings of Hirschsprung disease, meconium ileus, and jejunoileal atresia on plain films and diagnostic contrast enema.