Bilious Vomiting in the Newborn: Rapid Diagnosis of Intestinal Obstruction

TABLE 1
Causes of Intestinal Obstruction with Bilious Vomiting in Neonates

PREOPERATIVE
DIAGNOSTIC
AGE OF ONSET MANAGEMENT
TYPE OF CAUSE AND PROCEDURE POSTOPERATIVE
AND INTERVAL TREATMENT PROGNOSIS
OBSTRUCTION INCIDENCE AND MANAGEMENT
PRESENTATIONS BEFORE
FINDINGS
SURGERY

Duodenal Embryogenic; Few hours after Abdominal Nasogastric Diamond-shaped No oral intake, Good unless
atresia occurs in 1 per birth; bilious film, “double- suction, IV fluids; duodenoduodenostomy nasogastric associated
5,000 live vomiting, no bubble” sign 24 to 48 hours suction; feeding with serious
births; 25% distention at 2 to 3 days anomalies
have Down after surgery
syndrome

Malrotation with Incomplete At 3 to 7 days; Upper GI spiral Nasogastric Ladd's procedure; may No oral intake; Good
volvulus bowel rotation bilious vomiting, sign on suction, IV fluid; require a second nasogastric without
occurring rapid ultrasound; STAT surgery for laparotomy suction bowel
during 7th to deterioration with abnormal symptomatic resection,
12th weeks of volvulus location of the patients, within difficult with
gestation superior daysfor others short-gut
mesenteric syndrome
vessels after bowel
resection

Jejunoileal Mesenteric Within 24 hours Air-fluid levels Nasogastric Resection(s) and No oral intake, Good unless
atresia vascular of birth; vomiting, on abdominal suction, IV fluids; anastomosis(es) nasogastric excessive
accident during abdominal film 12 to 24 hours suction; feeding loss of
fetal life in 1 distention at 2 to 4 days bowel
per 3,000 live after surgery
births
 PREOPERATIVE
DIAGNOSTIC
AGE OF ONSET MANAGEMENT
TYPE OF CAUSE AND PROCEDURE POSTOPERATIVE
AND INTERVAL TREATMENT PROGNOSIS
OBSTRUCTION INCIDENCE AND MANAGEMENT
PRESENTATIONS BEFORE
FINDINGS
SURGERY

Meconium ileus Genetic, occurs Immediately after Abdominal Decompression Enterostomy if Acetylcysteine Depends on
in 15% of birth; abdominal film; distention, complicated; (Mucomyst), the systemic
newborns with distention, bilious air-fluid levels, Gastrografin enema pancreatic problems
cystic fibrosis, vomiting sweat test, plus IV fluids enzymes
and in 1 per “ground-glass”
5,000 to 10,000 sign
live births

Necrotizing Cause 10 to 12 days Abdominal Nasogastric Resection of necrotic Same as 25% need
ileus unknown in 2.4 after birth; film; distention, suction, IV fluids, bowel and enterostomy preoperative surgery
per 1,000 live distention, pneumatosis, nutrition, management (65%
births vomiting, bloody air in the aortal antibiotics for 10 survival rate)
stools vein days. When 75% can be
perforated, treated
immediate medically
surgery (95%
survival rate)

IV = intravenous; GI = gastrointestinal.

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