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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 birth; bilious film, “double- suction, IV duodenoduodenostomy nasogastric associated
per 5,000 live vomiting, no bubble” sign fluids; 24 to 48 suction; feeding with serious
births; 25% distention hours at 2 to 3 days anomalies
have Down after surgery
syndrome

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

Jejunoileal Mesenteric Within 24 hours Air-fluid Nasogastric Resection(s) and No oral intake, Good unless
atresia vascular of birth; vomiting, levels on suction, IV anastomosis(es) nasogastric excessive
accident abdominal abdominal fluids; 12 to 24 suction; feeding loss of
during fetal distention film hours at 2 to 4 days bowel
life in 1 per after surgery
3,000 live
births

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

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

IV = intravenous; GI = gastrointestinal.

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