A 24-hour-old male infant born at 37 weeks of gestation via repeat cesarean delivery was evaluated for emesis that was not bilious or bloody. He had not passed any stools since birth. His prenatal course was complicated by maternal use of buprenorphine to manage an addiction disorder. His mother had declined prenatal genetic testing.

Physical examination revealed slanted palpebral fissures; small, low-set ears; and a flat frontal bridge. He had a large forehead with frontal bossing, short neck with posterior fat pad, and widened space between the first and second toes. Cardiac examination revealed a II/VI holosystolic murmur, best heard at the left lower sternal border. The newborn had a palpable abdominal bowel and a patent anus without meconium plug.

Radiography showed gaseous distention of bowel loops with dilation measuring up to 2.7 cm (Figure 1). No air was identified within the rectum.

QUESTION

Based on the patient's history and physical examination, which one of the following is the most likely diagnosis?

• A. Duodenal atresia.

• B. Hirschsprung disease.

• C. Malrotation of the bowel.

• D. Meconium ileus.

• E. Volvulus.