A neonate presented with fever, lethargy, abdominal distension, vomiting and constipation. Clinically he was diagnosed as volvulus neonatarum with suspected perforation. Best investigation would be:
In a case of suspected perforation plain x-ray should be performed. It shows free air under the diaphragm and confirms the diagnosis of perforation. Ref: Jones' Clinical Paediatric Surgery : Diagnosis and Management By Peter G. Jones, John M. Hutson, Alan A Woodward, Page 40; Walker's Pediatric Gastrointestinal Disease : Physiology, Diagnosis By W. Allan Walker, Volume 2, Page 1420
Plain X-ray
Barium enema
Upper GI endoscopy
Barium meal follow through