[size=6]You are called by the emergency department to consult on a ten-day old full term male infant with bilious vomiting. The baby is hemodynamically stable and the abdominal exam is unremarkable. An abdominal ultrasound obtained by the emergency physician suggests that the superior mesenteric artery lies to the right of the vein and that there might be “swirl sign”. Your plan in this patient with bilious vomiting should be immediate

 

A repeat the ultrasound with graded compression

 

B upper gastrointestinal series.

 

C contrast enema.

 

D computerized tomography of the abdomen.

 

E laparotomy.[/size]

B

B

B

[size=6]You are called by the emergency department to consult on a ten-day old full term male infant with bilious vomiting. The baby is hemodynamically stable and the abdominal exam is unremarkable. An abdominal ultrasound obtained by the emergency physician suggests that the superior mesenteric artery lies to the right of the vein and that there might be “swirl sign”. Your plan in this patient with bilious vomiting should be immediate

 

A repeat the ultrasound with graded compression

 

B upper gastrointestinal series.

 

C contrast enema.

 

D computerized tomography of the abdomen.

 

E laparotomy.[/size]

E

E

E

E

[size=6]You are called by the emergency department to consult on a ten-day old full term male infant with bilious vomiting. The baby is hemodynamically stable and the abdominal exam is unremarkable. An abdominal ultrasound obtained by the emergency physician suggests that the superior mesenteric artery lies to the right of the vein and that there might be “swirl sign”. Your plan in this patient with bilious vomiting should be immediate

 

A repeat the ultrasound with graded compression

 

B upper gastrointestinal series.

 

C contrast enema.

 

D computerized tomography of the abdomen.

 

E laparotomy.[/size]

E

Correct answer

B upper gastrointestinal series.

 

as long as the child is hemodynamically stable & abdomen not surgical, upper gastrointestinal study should be done to confirm diagnosis. if child is shocked/septic surgical exploration should not be delayed waiting for imaging.

[size=6]You are called by the emergency department to consult on a ten-day old full term male infant with bilious vomiting. The baby is hemodynamically stable and the abdominal exam is unremarkable. An abdominal ultrasound obtained by the emergency physician suggests that the superior mesenteric artery lies to the right of the vein and that there might be “swirl sign”. Your plan in this patient with bilious vomiting should be immediate

 

A repeat the ultrasound with graded compression

 

B upper gastrointestinal series.

 

C contrast enema.

 

D computerized tomography of the abdomen.

 

E laparotomy.[/size]

E

B

B

The ultrasound findings are suggestive but not definitive. In a stable infant with an equivocal ultrasound, an immediate UGI contrast study is appropriate to assess for malrotation and midgut volvulus. Reversal of the mesenteric vessels alone does not establish the diagnosis.If ultrasound demonstrates a definite whirlpool sign confirming volvulus, urgent surgery is indicated without delaying for further imaging. Thus, E would be appropriate for confirmed volvulus, whereas the wording might be supports B here.