When the clinical and laboratory assessment provides a definitive diagnosis and treatment plan, radiologic imaging is not required. Clinical diagnostic uncertainty may require use of imaging. Often the initial imaging helps in determining whether the patient has bowel obstruction and may provide insight into whether it is proximal or distal obstruction. In some cases, other imaging is necessary to provide diagnosis that is more definitive, help with surgical approach, and diagnose cases that require urgent surgery. OR Discussion of Procedures by Variant Variant 1: Vomiting within the first 2 days after birth. Poor feeding or no passage of meconium. Initial imaging. Bilious vomiting in the first days after birth is an ominous sign that suggests the possibility of bowel obstruction and in some cases the need for urgent surgery. In a study of 45 patients with bilious vomiting in the first 72 hours of life, 20% had midgut volvulus and 11% had a lower GI cause (meconium plug syndrome or left-sided microcolon) [6]. Vomiting usually begins in the first 2 days after birth in children with intestinal atresia and is usually bilious. Bilious vomiting and gastric distension suggest proximal bowel obstruction. About 15% of children with proximal bowel obstruction will have nonbilious vomiting [7]. No passage of meconium and yellow colostrum or vomitus with meconium is typical for distal bowel obstruction. Imaging has a role for definitive diagnosis of bowel obstruction as a cause of the vomiting; it can differentiate between proximal and distal obstruction and exclude midgut volvulus that requires urgent surgery. Radiography Abdomen When evaluating a newborn with vomiting after birth, especially when there is bilious vomiting, the initial concern is to identify diseases that require emergent surgical management, specifically, malrotation with midgut volvulus and intestinal atresias.
Vomiting in Infants. When the clinical and laboratory assessment provides a definitive diagnosis and treatment plan, radiologic imaging is not required. Clinical diagnostic uncertainty may require use of imaging. Often the initial imaging helps in determining whether the patient has bowel obstruction and may provide insight into whether it is proximal or distal obstruction. In some cases, other imaging is necessary to provide diagnosis that is more definitive, help with surgical approach, and diagnose cases that require urgent surgery. OR Discussion of Procedures by Variant Variant 1: Vomiting within the first 2 days after birth. Poor feeding or no passage of meconium. Initial imaging. Bilious vomiting in the first days after birth is an ominous sign that suggests the possibility of bowel obstruction and in some cases the need for urgent surgery. In a study of 45 patients with bilious vomiting in the first 72 hours of life, 20% had midgut volvulus and 11% had a lower GI cause (meconium plug syndrome or left-sided microcolon) [6]. Vomiting usually begins in the first 2 days after birth in children with intestinal atresia and is usually bilious. Bilious vomiting and gastric distension suggest proximal bowel obstruction. About 15% of children with proximal bowel obstruction will have nonbilious vomiting [7]. No passage of meconium and yellow colostrum or vomitus with meconium is typical for distal bowel obstruction. Imaging has a role for definitive diagnosis of bowel obstruction as a cause of the vomiting; it can differentiate between proximal and distal obstruction and exclude midgut volvulus that requires urgent surgery. Radiography Abdomen When evaluating a newborn with vomiting after birth, especially when there is bilious vomiting, the initial concern is to identify diseases that require emergent surgical management, specifically, malrotation with midgut volvulus and intestinal atresias.