Case 2: Bilious Drainage From an Orogastric Tube in a Preterm Infant

A male infant is noted on the first day after delivery to have a tense, drumlike, and distended abdomen with bilious output from an orogastric sump. He was born via cesarean section at ![Graphic][1] weeks’ gestation to a 19-year-old primigravid mother for fetal intolerance to labor after induction for preterm premature rupture of membranes. His mother denied previous use of medications other than prenatal vitamins, progesterone, and occasional acetaminophen. She also denied use of tobacco, alcohol, and illicit drugs. First trimester screening results were normal, although an α-fetoprotein level was not measured. However, a 20-week ultrasonogram revealed a herniated portion of bowel to the right of the umbilical cord insertion. This defect, similar but now smaller, was again noted on a follow-up 27-week ultrasonogram. However, the extra-abdominal bowel then vanished on both the 31- and 33-week ultrasonograms. On these late ultrasonograms, the only remaining intestinal abnormality was portions of intra-abdominal bowel that appeared to be abnormally dilated. Because of the abnormal prenatal ultrasonograms, the surgical team is present at delivery to assess the infant’s status. Interestingly, he does not have any abdominal wall defect and has a normally inserted umbilical cord that does not contain any herniated intestine. Other than a mildly distended abdomen, his examination findings are normal, and he is appropriate for gestational age (birth weight, 2,050 g). The surgical team leaves, and an orogastric sump is placed because of the abdominal distension. Radiography is performed to further assess the infant’s abdomen. Initial radiographs reveal a paucity of … [1]: /embed/inline-graphic-1.gif