A 2-day-old, twin (first-born), male newborn presents with abdominal distention, nonbilious vomiting, and failure to pass meconium. The umbilical cord is noted to have swelling and erythema (Fig 1).

Twin 1 was sent to the neonatal intensive care unit because of the need for intravenous fluids management. Oral feeds were started slowly at 12 hours after birth, and after 4 feeds, vomiting (nonbilious and nonprojectile) and abdominal distention were noted. No meconium passage was recorded by age 48 hours. Feeds were suspended, and further studies performed.

Radiography was also ordered (Fig 2).

Because of the clinical and radiologic evidence of intestinal obstruction, a colonic enema was ordered with hydrosoluble material. The study revealed colonic permeability with caliber diminution (microcolon) and medium passage to the terminal ileum with exit of the contrast medium through the umbilical cord (Fig 3).

A diagnosis of ileal stenosis with...

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