Bilious emesis in an infant is malrotation until proven otherw | Paediatrics videos & books

Bilious emesis in an infant is malrotation until proven otherwise. Malrotation can lead to a midgut volvulus. The volvulus can result in bowel ischemia and necrosis. This makes bilious emesis in a newborn a concerning finding. Pyloric stenosis would cause nonbilious emesis. Imperforate anus would present with the failure of stool passage. Diaphragmatic hernia will present with poor feeding, drooling, and respiratory embarrassment. The best radiographic test in the diagnosis of malrotation is an UGI contrast study with small bowel follow through. This will identify the duodenum and its location relative to the ligament of Treitz. The characteristic finding in a midgut volvulus is the “corkscrew” sign, which is seen as contrast media traverses the kinked intestine. An abdominal CT may show malrotation but is less specific for it. Barium enema and radionuclide scans have no role in the diagnosis of malrotation.