Question

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. Plain X-ray
• B. Barium enema
• C. Upper GI endoscopy
• D. Barium meal follow through

Hint:

Suspected perforation means look for free air and never give barium.

Answer 1

The Correct Option is A

Step 1: The key phrase is suspected perforation. Once perforation is suspected, the first concern is to look for free air in the abdomen and to avoid any contrast that could leak into the peritoneum.
Step 2: A plain X-ray of the abdomen, taken erect or as a lateral decubitus film, shows free gas under the diaphragm or along the abdominal wall when there is a perforation. It is quick, safe and needs no contrast, so it is the best first investigation in a sick neonate with suspected perforation.
Step 3: Why the contrast studies are wrong here. Barium is strongly contraindicated when perforation is suspected, because barium leaking into the peritoneum causes a severe, often fatal chemical peritonitis. This rules out both barium enema and barium meal follow through. If contrast is truly needed, a water-soluble agent is used, not barium.
Step 4: Upper GI endoscopy has no role in diagnosing a neonatal perforation or volvulus and is unsafe in this setting.
Step 5: The best investigation is a plain X-ray to detect free air.
Answer: Option A, Plain X-ray.