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?

 

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 colombia

I would suspect a duodenal stenosis, perhaps an annular pancreas. Does the patient have trisomy 21?

I would repeat the UGI​.

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 !

Possible to wait couple days but preferably to operate and proceed as per findings

Laparoscopia diagnostica y terapéutica dependiendo de los hallazgos

Translation:

Diagnostic and therapeutic laparoscopy depending on the findings

Duodenal Web may usually extend down due to hyperpersilstatic bowel,which give impression of distal small bowel obstruction.

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