In some cases in which there is inadequate gastric or duodenal distention, air can be injected to the stomach through the feeding tube to better delineate the gas pattern and confirm no gas distally. Nuclear Medicine Gastroesophageal Reflux Scan There is no relevant literature to support the use of reflux scintigraphy using Tc-99m sulfur colloid or Tc-99m DTPA or Tc-99m MAA in evaluating the neonate with acute vomiting and classic double bubble or triple bubble with no gas distally. US Abdomen (UGI Tract) There is a growing acceptance for the role of US, especially in prenatal diagnosis of duodenal atresia. In the postnatal diagnosis of duodenal atresia, there is no relevant literature to support the use of US in evaluating the neonate with acute vomiting and classic double bubble or triple bubble with no gas distally. Variant 3: Vomiting within the first 2 days after birth. Radiographs show a distal bowel obstruction. Next imaging study. The role of imaging in children with multiple distended bowel loops with no or decreased gas distally is to differentiate between temporary functional abnormalities that only need observation (eg, meconium plug), pathologies that require surgery (eg, ileal atresia), therapeutic enema (eg, meconium ileus), or rectal biopsy (eg, Hirschsprung disease) [12]. Fluoroscopy Contrast Enema Contrast enema is the diagnostic imaging procedure of choice when there is a suspected distal obstruction. Congenital distal obstruction can be structural or functional, in which both will give the same appearance on abdominal radiographs that show numerous dilated bowel loops with an absence or paucity of distal gas. In the setting of congenital atresia, most commonly ileal, but also distal jejunal or colonic, the lack of contents moving through the bowel results in a microcolon [12]. Fluoroscopy Upper GI Series There is no relevant literature to support the use of a UGI series in the evaluation of the neonate with suspected distal obstruction.
Vomiting in Infants. In some cases in which there is inadequate gastric or duodenal distention, air can be injected to the stomach through the feeding tube to better delineate the gas pattern and confirm no gas distally. Nuclear Medicine Gastroesophageal Reflux Scan There is no relevant literature to support the use of reflux scintigraphy using Tc-99m sulfur colloid or Tc-99m DTPA or Tc-99m MAA in evaluating the neonate with acute vomiting and classic double bubble or triple bubble with no gas distally. US Abdomen (UGI Tract) There is a growing acceptance for the role of US, especially in prenatal diagnosis of duodenal atresia. In the postnatal diagnosis of duodenal atresia, there is no relevant literature to support the use of US in evaluating the neonate with acute vomiting and classic double bubble or triple bubble with no gas distally. Variant 3: Vomiting within the first 2 days after birth. Radiographs show a distal bowel obstruction. Next imaging study. The role of imaging in children with multiple distended bowel loops with no or decreased gas distally is to differentiate between temporary functional abnormalities that only need observation (eg, meconium plug), pathologies that require surgery (eg, ileal atresia), therapeutic enema (eg, meconium ileus), or rectal biopsy (eg, Hirschsprung disease) [12]. Fluoroscopy Contrast Enema Contrast enema is the diagnostic imaging procedure of choice when there is a suspected distal obstruction. Congenital distal obstruction can be structural or functional, in which both will give the same appearance on abdominal radiographs that show numerous dilated bowel loops with an absence or paucity of distal gas. In the setting of congenital atresia, most commonly ileal, but also distal jejunal or colonic, the lack of contents moving through the bowel results in a microcolon [12]. Fluoroscopy Upper GI Series There is no relevant literature to support the use of a UGI series in the evaluation of the neonate with suspected distal obstruction.