In necrotising enterocolitis earliest change seen in X–ray abdomen is –
**Core Concept**
Necrotizing enterocolitis (NEC) is a devastating condition characterized by ischemic injury and necrosis of the intestinal tissue, often seen in premature infants. The early detection of NEC is crucial for prompt intervention. Radiographic findings play a vital role in diagnosing NEC.
**Why the Correct Answer is Right**
The earliest change seen in NEC on an abdominal X-ray is the **pneumatosis intestinalis**, which refers to the presence of gas within the intestinal wall. This occurs due to the bacterial overgrowth and the breakdown of the intestinal mucosa, leading to the release of gas into the intestinal wall. The gas can be seen as bubbles or linear collections within the intestinal wall, often in the form of a **bubbly or bubbly-coated appearance**.
**Why Each Wrong Option is Incorrect**
* **Option A:** **Portal venous gas** is a complication of NEC but not the earliest change seen on X-ray. It occurs when gas enters the portal venous system, which is a more advanced and severe manifestation of NEC.
* **Option B:** **Free air** is indicative of a perforation, which is a late complication of NEC. While it is a significant finding, it is not the earliest change seen on X-ray.
* **Option C:** **Gaseous distension of the bowel** is a non-specific finding that can be seen in various conditions, including NEC, but it is not the earliest change specific to NEC.
**Clinical Pearl / High-Yield Fact**
Remember the **"3 Fs"** of NEC: **Fever, feeding intolerance, and fussiness**. These symptoms are often the first signs of NEC, and prompt investigation is essential to prevent further complications.
**Correct Answer: C. Pneumatosis intestinalis.**