There are some bowel gas patterns that can guide management; double bubble with no distal gas (classic double bubble) or triple bubble with no distal gas, double bubble with distal gas (nonclassic double bubble), and multiple distended bowel loops with no or decreased distal gas (see Variants 2 and 4) [8]. Fluoroscopy Contrast Enema Although beginning the workup with a contrast enema may lead to a diagnosis, there is no relevant literature to support the use of performing a contrast enema as the initial imaging study prior to an abdominal radiograph. Fluoroscopy Upper GI Series Although beginning the workup with an upper GI (UGI) series may lead to a diagnosis, there is no relevant literature to support the use of performing a UGI series as the initial imaging study prior to an abdominal radiograph. 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 diethylenetriamine pentaacetic acid (DTPA) or Tc-99m microaggregated albumin (MAA) in the initial imaging evaluation of the neonate with acute bilious vomiting. Vomiting in Infants US Abdomen (UGI Tract) There is no relevant literature to support the use of ultrasound (US) as the initial imaging examination prior to an abdominal radiograph for the neonate with acute bilious vomiting. Fluoroscopy Contrast Enema In the setting of a suspected proximal atresia with absent distal bowel gas, there is no relevant literature to support the use of a contrast enema for diagnosis. Atresias can be multiple in approximately 15% of patients. Most of these can be diagnosed at the initial surgical exploration [11]. Fluoroscopy Upper GI Series In the setting of a classic double bubble or triple bubble with no gas distally, a UGI series is usually not necessary, because the positive contrast used in fluoroscopy does not typically provide more anatomic details.
Vomiting in Infants. There are some bowel gas patterns that can guide management; double bubble with no distal gas (classic double bubble) or triple bubble with no distal gas, double bubble with distal gas (nonclassic double bubble), and multiple distended bowel loops with no or decreased distal gas (see Variants 2 and 4) [8]. Fluoroscopy Contrast Enema Although beginning the workup with a contrast enema may lead to a diagnosis, there is no relevant literature to support the use of performing a contrast enema as the initial imaging study prior to an abdominal radiograph. Fluoroscopy Upper GI Series Although beginning the workup with an upper GI (UGI) series may lead to a diagnosis, there is no relevant literature to support the use of performing a UGI series as the initial imaging study prior to an abdominal radiograph. 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 diethylenetriamine pentaacetic acid (DTPA) or Tc-99m microaggregated albumin (MAA) in the initial imaging evaluation of the neonate with acute bilious vomiting. Vomiting in Infants US Abdomen (UGI Tract) There is no relevant literature to support the use of ultrasound (US) as the initial imaging examination prior to an abdominal radiograph for the neonate with acute bilious vomiting. Fluoroscopy Contrast Enema In the setting of a suspected proximal atresia with absent distal bowel gas, there is no relevant literature to support the use of a contrast enema for diagnosis. Atresias can be multiple in approximately 15% of patients. Most of these can be diagnosed at the initial surgical exploration [11]. Fluoroscopy Upper GI Series In the setting of a classic double bubble or triple bubble with no gas distally, a UGI series is usually not necessary, because the positive contrast used in fluoroscopy does not typically provide more anatomic details.