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 the evaluation of the neonate with suspected distal obstruction. US Abdomen (UGI Tract) There is no relevant literature to support the use of US in the evaluation of the neonate with suspected distal obstruction. Vomiting in Infants Variant 4: Bilious vomiting within the first 2 days after birth. Radiographs show a nonclassic double bubble with gas in the distal small bowel, or few distended bowel loops, or a normal bowel gas pattern. Next imaging study. The role of imaging in a child with bilious vomiting in the first 2 days of life with nonclassic double bubble or few distended bowel loops is to differentiate between congenital intestinal atresia and stenosis and midgut volvulus, which requires urgent surgery. Malrotation or midgut volvulus with incomplete obstruction may have a normal bowel gas pattern [5,6,11]. Fluoroscopy Contrast Enema Abnormalities of the lower GI tract that cause bilious vomiting may be demonstrated by contrast enema [4,13]. The use of a barium enema for analyzing malrotation is less direct than analysis of a UGI series. Approximately 20% of barium enemas may be falsely negative, whereas up to 15% of infants have a high mobile cecum that may cause false-positive interpretations of the study [14]. 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 the evaluation of the neonate with acute bilious vomiting. Although US has limitation for the diagnosis of malrotation, there are a few studies showing high sensitivity and specificity for midgut volvulus. The US finding of the whirlpool sign (a clockwise wrapping of the SMV and mesentery around the SMA as the fixed axis) is specific for volvulus [15,26-28].
Vomiting in Infants. 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 the evaluation of the neonate with suspected distal obstruction. US Abdomen (UGI Tract) There is no relevant literature to support the use of US in the evaluation of the neonate with suspected distal obstruction. Vomiting in Infants Variant 4: Bilious vomiting within the first 2 days after birth. Radiographs show a nonclassic double bubble with gas in the distal small bowel, or few distended bowel loops, or a normal bowel gas pattern. Next imaging study. The role of imaging in a child with bilious vomiting in the first 2 days of life with nonclassic double bubble or few distended bowel loops is to differentiate between congenital intestinal atresia and stenosis and midgut volvulus, which requires urgent surgery. Malrotation or midgut volvulus with incomplete obstruction may have a normal bowel gas pattern [5,6,11]. Fluoroscopy Contrast Enema Abnormalities of the lower GI tract that cause bilious vomiting may be demonstrated by contrast enema [4,13]. The use of a barium enema for analyzing malrotation is less direct than analysis of a UGI series. Approximately 20% of barium enemas may be falsely negative, whereas up to 15% of infants have a high mobile cecum that may cause false-positive interpretations of the study [14]. 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 the evaluation of the neonate with acute bilious vomiting. Although US has limitation for the diagnosis of malrotation, there are a few studies showing high sensitivity and specificity for midgut volvulus. The US finding of the whirlpool sign (a clockwise wrapping of the SMV and mesentery around the SMA as the fixed axis) is specific for volvulus [15,26-28].