Pneumatosis intestinalis on radiographs is most characteristic of which condition?

• A. Necrotizing enterocolitis
• B. Duodenal atresia
• C. Intussusception
• D. Malrotation

Answer: (A)

Pneumatosis intestinalis, gas within the bowel wall, is a hallmark radiographic finding of necrotizing enterocolitis in newborns, especially in premature infants. This pattern reflects bowel wall ischemia and gas-producing bacteria, and it often appears with other NEC signs such as portal venous gas or distension, signaling possible progression to perforation. Duodenal atresia usually shows a double bubble sign with little distal gas and isn’t characterized by intramural gas. Intussusception presents with an illustrative ultrasound or plain-film signs like a target or crescent pattern and isn’t defined by gas within the bowel wall. Malrotation can cause abnormal bowel positioning and volvulus-related obstruction, but pneumatosis intestinalis isn’t its typical feature. Thus, pneumatosis intestinalis is most characteristic of necrotizing enterocolitis.