This document discusses bilious vomiting in infants and provides potential differential diagnoses and treatments. Malrotation of the midgut is the most common cause of bilious vomiting in infants until proven otherwise. Other potential causes include bowel atresias like duodenal or jejunoileal atresia, Hirschsprung's disease, necrotizing enterocolitis, and meconium ileus. Treatment depends on the diagnosis but initially involves stabilizing the infant and NG decompression followed by specific treatments like surgery for malrotation or atresias.

1. Bilious emesis in Infants
Dr Surjeet Acharya
Emergency Physician

2. Dr Surjeet Acharya
Acute and Critical Care Medicine
MBBS, MEM (USA), MRCEM (UK)

3. What does bilious mean?
Bilious simply mean “presence of bile”.
Bile?
Greenish fluid secreted by the liver for digestion of lipids/fats in the GIT.

4. Differential diagnosis in infants with bilious vomiting
SURGICAL MEDICAL
Malrotation Sepsis
Incarcerated hernias Necrotizing enterocolitis
Bowel atresia GERD
Hirschsprung's disease Metabolic
Meconium ileus
Malrotation of midgut is
the reason for bilious
vomiting in infant until
proven otherwise
Rescorla FJ, Shedd FJ, Grosfeld JL, Vane DW, West KW.
Anomalies of intestinal rotation in childhood: analysis
of 447 cases. Surgery. 1990;108:710-5.
Duodenal atresia
Jejunoileal atresia

5. Malrotation
Midgut volvulus is the M.C malrotation seen in paediatric population
LADD’s band

6. I.O.C
UGI series

7. Treatment
Airway
Breathing
Circulation
NPO
NG TUBE
IV FLUIDS, ANTIBIOTICS
LADD’s procedure

8. Bowel Atresia
Duodenal atresia Jejunoileal atresia
Bilious vomiting with no abdominal
distension
Occurs within few hours of birth
Abdominal Xray showing - “double
buddle sign”
Treatment :
ABC - NPO, NG tube, IV fluids
Diamond-shaped
duodenoduodenostomy
Bilious vomiting with abdominal
distension
Occurs within 24 hours of birth
Abdominal Xray showing - “multiple
air fluid level”
Treatment :
ABC - NPO, NG tube, IV fluids
Resection(s) and
anastomosis(es)

9. DOUBLE BUBBLE SIGN
MULTIPLE AIR-FLUID LEVEL

11. Hirschsprung's disease

13. Necrotizing enterocolitis

15. MODIFIED BELL’s AND STAGE CRITERIA

16. Management
A-B-C
NG TUBE
IV FLUIDS
ANTIBIOTICS
OPERATE
# M C Walsh, R M Kliegman, PMID: 3081865, PMCID: PMC7131118 DOI: 10.1016/s0031-3955(16)34975-6

17. Meconium ileus

18. Management
Investigations - routine blood, sweat test (cystic fibrosis)),
Abdominal Xray
Treatment:
A-B-C
NPO, Gastrograffin with IV fluids
NG tube
Decompression
Enterostomy (complicated)

19. Other causes
1. GERD - diagnosis based on clinical symptoms, treatment usually
symptomatic, no other diagnostic tests required, until symptoms not improved
by treatment
1. Sepsis - treat the underlying medical condition

20. Summary

21. THANK YOU