The vomiting of bile-stained fluid in the first few days of life should be considered intestinal obstruction until proven otherwise

The vomiting of bile-stained fluid in the first few days of life should be considered intestinal obstruction until proven otherwise: Excerpt from Avoiding Common Pediatric Errors

Author: Cynthia Gibson, MD

What to Do - Interpret the Data

Intestinal obstruction, often atresia, presents in the first few days of life as bilious vomiting sometimes accompanied by abdominal distention and failure to pass meconium. Infants are often premature and small for gestational age and a prenatal diagnosis may be made in babies with polyhydramnios. Intestinal obstruction with bilious vomiting in neonates is caused by duodenal atresia, malrotation, volvulus, jejunoileal atresia, meconium ileus, and necrotizing enterocolitis. Babies with stenosis present as newborns or later with recurrent vomiting and failure to thrive.

The diagnosis can be made on the presenting symptoms and plain abdominal x-rays. The presence of dilated bowel loops and air-fluid levels should prompt urgent consultation with a pediatric surgeon. The number of dilated loops usually indicates the level of obstruction and contrast studies are not required to make the diagnosis. Patients presenting with delayed symptoms may need an upper gastrointestinal study with small bowel follow through to assess for a midgut stenosis. Treatment of intestinal atresia is operative following adequate fluid resuscitation and electrolyte correction.

Suggested Readings

GoscheJ,VickL,BoulangerSC, etal.Midgutabnormalities. SurgClin NorthAm. 2006;86:285– 299.
Halter J, Basel T, Nicolette L, et al. Common gastrointestinal problems and emergencies in neonates and children. Clin Fam Prac. 2004;6:731–754.
Kimura K, Loening-Baucke V. Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction. Am Fam Physician. 2000;61:2791–2798.

Book Source Details

• Book Title: Avoiding Common Pediatric Errors
• Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
• Year of Publication: 2008
• Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Avoiding Common Pediatric Errors Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7489-6

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