Review Question - QID 109248

A 4-week-old girl is evaluated in the neonatal intensive care unit for feeding intolerance with gastric retention of formula. She was born at 25 weeks gestation to a 32-year-old G1P1 due to preterm premature rupture of membranes at 24 weeks of gestation. The patient’s birth weight was 750 g (1 lb 10 oz). She required resuscitation with mechanical ventilation at the time of delivery, but she was subsequently extubated to continuous positive airway pressure (CPAP) and then weaned to a nasal cannula. The patient was initially receiving both parenteral nutrition and enteral feeds through a nasogastric tube, but she is now receiving only continuous nasogastric formula feeds. Her feeds are being advanced to a target weight gain of 20-30 g per day. Her current weight is 1,350 g (2 lb 16 oz). The patient’s temperature is 97.2°F (36.2°C), blood pressure is 72/54 mmHg, pulse is 138/min, respirations are 26/min, and SpO2 is 96% on 4L nasal cannula. On physical exam, the patient appears lethargic. Her abdomen is soft and markedly distended. A digital rectal exam reveals stool streaked with blood in the rectal vault. Which of the following abdominal radiographs would most likely be seen in this patient?