Question 86

Question:

An infant is rushed to the ER for profuse vomiting and you are asked to evaluate him. You notice that the vomitus is bile tinged, and you become concerned about a possible congenital anomaly. What is the most likely diagnosis?

Correct Answer: D.  Midgut malrotation with volvulus

There is a key distinction to be made between nonbilious and bilious vomiting in general, and in infants in particular. The presence of bile in the vomitus indicates that the point of obstruction is distal to the ampulla of Vater. Bilious vomiting in infants is midgut malrotation with volvulus until proven otherwise.
Neonates with esophageal atresia typically present with excess secretions that can lead to drooling, choking, respiratory distress, and the inability to feed.
In hypertrophic pyloric stenosis, the point of obstruction is at the pylorus and thus this typically presents with nonbilious vomiting.
The other choices do not typically present with vomiting.