Department of Pathology, University of Oklahoma Health Sciences Center
A premature neonate (30 weeks of gestation) with feeding problems and abdominal distension.
Clinical information: The patient was a 3-week 5-day old baby boy born at the 30th week of gestation to a 27 year-old mother. The pregnancy was complicated by maternal ethanol use and prolonged premature rupture of membranes. The patient’s APGAR scores were 2 at 1 minute, 6 at 5 minutes, and 8 at 10 minutes. After delivery, the patient was admitted to the intensive care unit for prematurity, possible sepsis, and respiratory distress. Blood cultures in the first week of life were negative. He was weaned off respiratory support shortly after the first week of life. Two weeks after birth, the patient began having some feeding intolerance with high residuals by gavage feeds. A few days later, he developed abdominal distention. An abdominal radiograph revealed free air, consistent with intestinal perforation. A Penrose drain was placed. The patient also had a tonic-clonic seizure at one point and then started having oxygen desaturations. His clinical condition deteriorated with metabolic acidosis, hypotension, cardiac arrhythmia, bradycardia, and hypoperfusion despite aggressive clinical treatments that included the use of vasopressors. He eventually succumbed to these multiple medical problems.
An autopsy was performed. The following are representative images of the gastrointestinal tract from the autopsy:
Click thumbnails
to see pictures.
Cases of the Month Evaluation Coordinator: KarMing-Fung@ouhsc.edu