Radiography Abdomen Abdominal radiographs have a limited role in determining subsequent imaging workup, keeping in mind that normal abdominal radiographs do not exclude the diagnosis of malrotation. In a group studied by Lilien et al [6], only 44% of patients who required surgery for bilious vomiting had definitively positive radiograph readings. If the radiographs do show signs of obstruction, the pattern of bowel distension can help direct further evaluation with an UGI series or contrast enema, respectively. Thus, although the plain radiograph may not be able to make the diagnosis of malrotation without supportive imaging, it may serve a complementary role to guide further imaging. Nuclear Medicine Gastroesophageal Reflux Scan Reflux scintigraphy can be highly effective in analyzing gastric emptying and GER, but 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 few studies showing high sensitivity and specificity for midgut volvulus. The US finding of the whirlpool sign is specific for volvulus [15,26-28]. It is important to recognize sonographic features of midgut volvulus because they can help to substantiate the diagnosis in an equivocal UGI study or when US is performed for other indications (eg, evaluation for HPS). Fluoroscopy Contrast Enema There is no relevant literature to support the use of contrast enema in the evaluation for GER. Fluoroscopy Upper GI Series Clinical practice guidelines on GER from 2001 [2] state that the sensitivity, specificity, and positive predictive values of a UGI series range from 31% to 86%, 21% to 83%, and 80% to 82%, respectively, when compared to esophageal pH monitoring. The recent clinical practice guidelines from the North American and European Societies Vomiting in Infants
Vomiting in Infants. Radiography Abdomen Abdominal radiographs have a limited role in determining subsequent imaging workup, keeping in mind that normal abdominal radiographs do not exclude the diagnosis of malrotation. In a group studied by Lilien et al [6], only 44% of patients who required surgery for bilious vomiting had definitively positive radiograph readings. If the radiographs do show signs of obstruction, the pattern of bowel distension can help direct further evaluation with an UGI series or contrast enema, respectively. Thus, although the plain radiograph may not be able to make the diagnosis of malrotation without supportive imaging, it may serve a complementary role to guide further imaging. Nuclear Medicine Gastroesophageal Reflux Scan Reflux scintigraphy can be highly effective in analyzing gastric emptying and GER, but 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 few studies showing high sensitivity and specificity for midgut volvulus. The US finding of the whirlpool sign is specific for volvulus [15,26-28]. It is important to recognize sonographic features of midgut volvulus because they can help to substantiate the diagnosis in an equivocal UGI study or when US is performed for other indications (eg, evaluation for HPS). Fluoroscopy Contrast Enema There is no relevant literature to support the use of contrast enema in the evaluation for GER. Fluoroscopy Upper GI Series Clinical practice guidelines on GER from 2001 [2] state that the sensitivity, specificity, and positive predictive values of a UGI series range from 31% to 86%, 21% to 83%, and 80% to 82%, respectively, when compared to esophageal pH monitoring. The recent clinical practice guidelines from the North American and European Societies Vomiting in Infants