Paeds Cases · gastroenterology-hepatology-and-nutrition
Bilious vomiting and intestinal obstruction — structured clinical encounter
Structured encounter testing the approach to a term neonate with sudden bilious vomiting: the recognition of malrotation with midgut volvulus as the emergency to exclude, the resuscitation and nasogastric decompression, the urgent upper gastrointestinal contrast study, the Ladd procedure, the differential of high and low obstruction, and the safety-netting and retrieval decisions for a rural family.
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Target exams
Station 1 — recognition
The examiner asks what worries me most about this baby. I explain that bright green bilious vomiting in a neonate is malrotation with midgut volvulus until proven otherwise, and that the soft, comfortable abdomen does not reassure me because tenderness, distension, blood in the stool and shock are all late signs that appear only once the bowel is ischaemic. I treat this as a surgical emergency immediately. [1] [2]
References6ShowHide
- [1]Godbole P; Stringer MD Bilious vomiting in the newborn: How often is it pathologic? J Pediatr Surg, 2002.PMID 12037761
- [2]Lampl B; Levin TL; Berdon WE; et al Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management. Pediatr Radiol, 2009.PMID 19241073
- [3]Salehi Karlslätt K; Husberg B; Ullberg U; et al Intestinal Malrotation in Children: Clinical Presentation and Outcomes. Eur J Pediatr Surg, 2024.PMID 36882104
- [6]Choi G; Je BK; Kim YJ Gastrointestinal Emergency in Neonates and Infants: A Pictorial Essay. Korean J Radiol, 2022.PMID 34983099
- [7]Rich BS; Bornstein E; Dolgin SE Intestinal Atresias. Pediatr Rev, 2022.PMID 35490204
- [12]Ingoe R; Lange P The Ladd's procedure for correction of intestinal malrotation with volvulus in children. AORN J, 2007.PMID 17292689