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Duodenal Atresia
12%
1/8
Mid-gut Volvulus
50%
4/8
Pyloric Stenosis
Biliary Atresia
25%
2/8
Meconium Ileus
0%
0/8
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A 5-day old infant presenting with green colored emesis, distention, and dilated loops of bowel on radiograph most likely has neonatal malrotation with volvulus. Malrotation with volvulus occurs due to an incomplete malrotation of the intestines during the 7-12th weeks of development. Patients will feed well until 3-7 days of life when bilious vomiting, abdominal distention, and rapid decompensation may occur. Complications of volvulus include intestinal ischemia, infection, necrosis, perforation of bowel, and ultimately shock. Kimura et al. discuss the importance of rapid diagnosis of small bowel obstruction following bilious vomiting and the importance of rapid treatment to prevent major complications. Following observation of bilious vomiting and abdominal distention, physicians must place a naso-gastric or oro-gastric tube for decompression followed by plain abdominal radiographs. If dilated loops of bowel and/or air fluid levels are observed intestinal obstruction should be suspected. Luang et al. discuss the treatment and cardinal signs of neonatal obstruction, which include maternal polyhydramnios, bilious emesis, failure to pass meconium first day, and abdominal distention. Radiographs aid in diagnosis but shouldn't delay treatment if suspected and treatment includes, NPO, fluid resuscitated, intravenous broad-spectrum antibiotics, and immediate operative exploration. Definitive treatment is the ladd procedure which detorses the bowel. Figure A demonstrates barium flowing in a corkscrew pattern in an upper gastrointestinal series. This is a common finding of midgut volvulus. Incorrect answers: Answer 1: Signs of duodenal atresia occur immediately after birth with bilious emesis and no abdominal distention. Answer 3: Pyloric stenosis does not present with bilious emesis or distention, occurs 3-5 weeks after birth, and an olive shaped mass would be palpated on physical exam. Answer 4: Biliary atresia does not present with distention, bilious vomiting, or these radiographic findings. Answer 5: Meconium ileus presents in babies with cystic fibrosis and, whot typically fail to pass stool on the first day of life.
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