Ascites

A 32-week gestational age, 3-week-old male infant in the neonatal intensive care unit develops progressive abdominal distension, feeding intolerance, and bilious gastric residuals over 24 hours. He is tachycardic and requires increased ventilator support. On examination, the abdomen is tense, tender, and has a palpable doughy mass in the right lower quadrant. Abdominal radiograph shows pneumatosis intestinalis and a paucity of gas in the right lower quadrant. A STAT bedside abdominal ultrasound reveals a moderate amount of complex ascites with internal debris and echogenic strands.