A female fetus is followed for a dilated, hyperperistaltic bowel loop persistent until birth. Films at 4 & 10 hours of life are shown. The baby has a normal exam, but she vomits bile after first feeding. Contrast enema and UGI performed simultaneously are read as normal. What would you do next?
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Answer selected by Admin at 11-07-2023, 05:25 PM.
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It's an interesting case, and although the patient has had bilious vomiting, which makes it surgical until proven otherwise, my next step would be to wait for 3-5 days for the "therapeutic" effect of oral contrast. If there is no improvement, I would perform a biopsy.
gustavo cala
bogota colombiaComment
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I would suspect a duodenal stenosis, perhaps an annular pancreas. Does the patient have trisomy 21?
I would repeat the UGI.Comment
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The X-ray at 10 hours is showing a dilated bowel loop. When you said the UGI and the enema read as normal . Did they manage to see the emptying of the stomach ? The quality of pics are not great .
my management would be , if these are normal , to put an Ng tube and be guided clinically with the aspirate colour and amount and the abdominal distension .
I would like to see if the baby has passed meconium? The amount ?
it can be plug or simple Me. Ileus and would clear with some washout if baby is stable and doesn’t have a surgical abdomen .
i will have a low threshold to explore this child looking for Atresia or complex Mec ileus ! The X-ray was showing some mixed air with stools at quite early stage !Comment
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Possible to wait couple days but preferably to operate and proceed as per findingsComment
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Laparoscopia diagnostica y terapéutica dependiendo de los hallazgosComment
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Duodenal Web may usually extend down due to hyperpersilstatic bowel,which give impression of distal small bowel obstruction.
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