An Abominable Abdomen

A 6-week-old (43 weeks’ postmenstrual age) boy presented to an outside hospital with a 1-day history of abdominal distention, fever, and watery stools with strands of blood intermixed. The patient’s medical history is significant for prematurity (born at 36 and 5/7 week’s gestation) and prenatal ultrasonography showing dilated bowel and stomach. The patient had a birthweight of 3,090 g (58th percentile on the Olsen weight-for-age premature baby growth chart for boys), birth length of 55 cm (99th percentile on the Olsen growth chart), and head circumference of 37 cm (99th percentile on the Olsen baby growth chart). After birth, he passed meconium on day 1 after birth, ate, voided, and stooled appropriately, with normal serial abdominal and genitourinary examination findings. He was evaluated daily by the pediatric and surgical services. Serial radiographs showed normal location of bowel loops, no dilated loops, and appropriate progression of the bowel gas pattern. The...