Coffee bean sign in a preterm neonate on an abdominal X-ray

A preterm male infant presented with abdominal distension and palpable bowel loops at 27 days of life. An abdominal X-ray showed a ‘coffee bean’ appearance of the bowel and raised the possibility of a sigmoid volvulus. Subsequent abdominal X-rays showed resolution of the coffee bean but the presence of intramural gas, and thus the infant was managed conservatively for necrotising enterocolitis. In this case a careful clinical evaluation with early imaging and multidisciplinary team discussion played an important role in ruling out sigmoid volvulus.

Vikranth Bapu Anna Venugopalan
Consultant Neonatologist

Ahmed Abdulaziz Omar Ahmed
Consultant Neonatologist

Francine Wootton
Advanced Neonatal Nurse Practitioner

Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust

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Keywords

sigmoid volvulus; necrotising enterocolitis (NEC); clinico-radiological correlation

Key points

The ‘coffee bean sign’ is a classical radiological presentation of a sigmoid volvulus, however this did not fit with the clinical presentation and stability of the baby in this case.
While the coffee bean sign might be a sign of sigmoid volvulus in older children and adults, X-ray appearances in preterm infants are often not ‘classic’ and may present unusual findings.
This case highlights the importance of clinical and radiological correlation.

Also published in Infant:

VOLUME 19 ISSUE 1/JANUARY 2023

Bovine-based breast milk fortifier and neonatal outcomes in premature infants of <32 weeks gestational age

Breast milk (maternal or donor) is the gold standard nutrition for preterm infants. Breast milk fortifier (BMF) provides supplementary nutrition to avoid the high growth failure rates in preterm infants. Conflicting reports have implicated BMF, especially bovine-based products, in the development of necrotising enterocolitis (NEC) and persistent safety concerns regarding BMF have led to variability in use across the UK and internationally. This study examines whether the use of bovine-based BMF in preterm infants plays a role in the development of NEC, or an increase in all-cause mortality.