Abstract
Background Bilious vomiting in the newborn is common and requires urgent attention to exclude malrotation. The proportion of neonates with surgical abnormalities, however, is small, and there are other causes. Study Objectives. We reviewed our experience of infants with bilious vomiting to demonstrate the importance of input from the tertiary surgical and medical team to arrive at the correct diagnosis. Design Admissions with bilious vomiting/aspirates of term born infants over a three-year period to a tertiary medical and surgical unit were reviewed. Results During the study period, 48 infants were admitted with bilious vomiting. Forty-five infants had upper gastrointestinal (UGI) contrast studies, and only six had an abnormal study: four had malrotation and two had Hirschsprung's disease. Of the infants with a normal UGI study, no cause was identified in 20 cases, 13 infants were treated for sepsis, one had a meconium plug, one an ovarian cyst, and two infants were polycythaemic. One infant was diagnosed with bilateral polymicrogyria (PMG) on brain MRI and another was found to have hypochondroplasia FGFR3 skeletal dysplasia. Conclusion Neonates with bilious vomiting may have a variety of underlying diagnoses and need to be referred to a tertiary surgical and medical centre to ensure appropriate diagnosis is made.
Highlights
Bilious vomiting or bilious aspirates in the newborn period requires urgent attention, as it may be the result of malrotation
An audit of bilious vomiting in term infants referred for paediatric surgical assessment demonstrated that only 11.7% had a surgical diagnosis, but no single test available in peripheral centres could have excluded a surgical diagnosis [4]. is audit demonstrated that there were a variety of nonsurgical diagnoses which were associated with bilious vomiting [4]
We have reviewed infants referred to our tertiary surgical and medical centre to emphasize the wide range of diagnoses that can be associated with bilious vomiting, and the importance of very thorough investigation of such infants should be performed by the tertiary surgical, and the tertiary medical team
Summary
Bilious vomiting in the newborn is common and requires urgent attention to exclude malrotation. e proportion of neonates with surgical abnormalities, is small, and there are other causes. E proportion of neonates with surgical abnormalities, is small, and there are other causes. We reviewed our experience of infants with bilious vomiting to demonstrate the importance of input from the tertiary surgical and medical team to arrive at the correct diagnosis. Admissions with bilious vomiting/aspirates of term born infants over a three-year period to a tertiary medical and surgical unit were reviewed. 48 infants were admitted with bilious vomiting. Of the infants with a normal UGI study, no cause was identified in 20 cases, 13 infants were treated for sepsis, one had a meconium plug, one an ovarian cyst, and two infants were polycythaemic. Neonates with bilious vomiting may have a variety of underlying diagnoses and need to be referred to a tertiary surgical and medical centre to ensure appropriate diagnosis is made
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