Question:medium
A neonate presented with fever, lethargy, abdominal distension, vomiting and constipation. Clinically he was diagnosed as volvulus neonatorum with suspected perforation. Best investigation would be:
A neonate presented with fever, lethargy, abdominal distension, vomiting and constipation. Clinically he was diagnosed as volvulus neonatorum with suspected perforation. Best investigation would be:
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Suspected perforation means look for free air and never give barium.
Updated On: Jun 24, 2026
- Plain X-ray
- Barium enema
- Upper GI endoscopy
- Barium meal follow through
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The Correct Option is A
Solution and Explanation
The whole answer turns on two words: suspected perforation. The moment a gut perforation is on the table, the priorities flip to confirming free intraperitoneal air and to keeping any harmful contrast out of the belly.
The investigation that does both is a plain abdominal radiograph. An erect or left lateral decubitus film reveals air under the diaphragm or outlining the bowel wall, which confirms perforation. It is fast, requires no preparation and carries no risk to an unstable newborn, so it is the correct first step.
Now the contrast options. Barium is absolutely forbidden when perforation is feared, because barium spilling into the peritoneal cavity triggers a brutal chemical peritonitis with high mortality. That eliminates both the barium enema and the barium meal follow through. When contrast is genuinely required in this scenario a water-soluble dye is chosen instead.
Upper GI endoscopy simply does not diagnose neonatal volvulus or perforation and would be dangerous. So the plain X-ray wins.
\[\boxed{\text{Plain X-ray}}\]
The investigation that does both is a plain abdominal radiograph. An erect or left lateral decubitus film reveals air under the diaphragm or outlining the bowel wall, which confirms perforation. It is fast, requires no preparation and carries no risk to an unstable newborn, so it is the correct first step.
Now the contrast options. Barium is absolutely forbidden when perforation is feared, because barium spilling into the peritoneal cavity triggers a brutal chemical peritonitis with high mortality. That eliminates both the barium enema and the barium meal follow through. When contrast is genuinely required in this scenario a water-soluble dye is chosen instead.
Upper GI endoscopy simply does not diagnose neonatal volvulus or perforation and would be dangerous. So the plain X-ray wins.
\[\boxed{\text{Plain X-ray}}\]
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