Upper gastrointestinal series in healthy neonates with bilious vomiting- Is it still obvious? A retrospective observational study.

Abstract

Demand for upper gastrointestinal contrast series (UGI) to investigate bilious vomiting (BV) has increased in recent years, mostly due to greater awareness of the need to rule out malrotation and midgut volvulus (MGV). We aimed to examine predictive value of clinical parameters in management of healthy neonates presenting with BV and re-assess the role of UGI in their management. A retrospective cohort study including medical, imaging and surgical data of neonates who underwent UGI due to BV. A total of 157 term neonates, eight neonates (5.1%) had confirmed surgical diagnosis of malrotation, five of them had malrotation with MGV, including two neonates who underwent extensive intestinal resection due to necrosis. Neonates with a combination of abnormal Plain radiograph and abdominal distention had 10 times higher odds of malrotation diagnosis, adjusting for age at first BV (p=0.017). Neonates with a combination of abnormal Plain radiograph, abdominal distention and abdominal tenderness had 25 times higher odds of MGV (p=0.002). This study reaffirms the role of UGI as the current main diagnostic tool for malrotation and MGV. Physical examination and Plain radiograph findings can help but cannot substitute UGI study.