Approach to constipation (pediatrics) Quiz: Ace Your Exams

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A 3-day-old boy is evaluated by the pediatric hospitalist after an uncomplicated vaginal delivery. The patient was born at 38 weeks gestation. There were no known complications during the pregnancy or delivery. However, there was limited prenatal care. Examination at delivery was notable for upslanting palpebral fissures, a flat-nasal bridge, and a protruding tongue. The patient has not yet passed meconium. Vital signs are within normal limits. Physical examination demonstrates a well-appearing infant in no acute distress. Head and neck examination are unchanged from birth. The abdomen is soft but distended. Lower abdominal fullness is present. Digital rectal examination results in an explosive expulsion of gas and liquid stool. An abdominal X-ray is obtained and seen below. Which of the following would confirm this patient’s diagnosis? 
  An abdominal X-ray shows dilated bowel loops, w/ 2 prominent air-filled loops in the upper abdomen. The letter 'R' is in the lower left corner. 
Reproduced from: Radiopaedia 

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