Paeds Vivas · fetal-neonatal-and-perinatal
Bilious vomiting and neonatal intestinal obstruction — branching viva
Branching viva on the rule that bilious vomiting is obstruction until proven otherwise, the proximal-versus-distal classification and imaging choice, the immediate resuscitation pathway, the time-critical midgut volvulus decision, and the condition-specific definitive surgery.
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Branch 1 — The rule and the colour test
Examiner: "The nurse tells you the vomit is green. What does that mean, and why?" [1]
A green or yellow-green vomit is bilious. Bile enters the duodenum at the ampulla of Vater, so for bile to appear in vomit obstruction must lie beyond the ampulla. This anatomical fact makes bilious vomiting a reliable bedside marker of obstruction and a surgical problem — I would treat it as obstruction until a contrast study or an operation says otherwise. [1]
References6ShowHide
- [1]Godbole P, Stringer MD Bilious vomiting in the newborn: How often is it pathologic? J Pediatr Surg, 2002.PMID 12037761
- [4]Patterson KN, Cruz S, Nwomeh BC Congenital duodenal obstruction - Advances in diagnosis, surgical management, and associated controversies. Semin Pediatr Surg, 2022.PMID 35305801
- [5]Svetanoff WJ, Srivatsa S, Diefenbach K Diagnosis and management of intestinal rotational abnormalities with or without volvulus in the pediatric population. Semin Pediatr Surg, 2022.PMID 35305800
- [7]Haricharan RN, Georgeson KE Hirschsprung disease. Semin Pediatr Surg, 2008.PMID 19019295
- [9]Sathe M, Houwen R Meconium ileus in Cystic Fibrosis. J Cyst Fibros, 2017.PMID 28986020
- [10]Hajivassiliou CA Intestinal obstruction in neonatal/pediatric surgery. Semin Pediatr Surg, 2003.PMID 14655163