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Virtual Pediatric Hospital: Paediapaedia: Approach to Bilious Vomiting Paediapaedia: Gastrointestinal Clinical and Radiographic Presentations, DDX, Approach to Imaging

Approach to Bilious Vomiting

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


DDX:

Approach/Discussion:
To distinguish between these possibilities, an upper GI exam is the study of choice, to determine the position of the ligament of Treitz, and to look for lumenal narrowing.

In the past, the barium enema was an often recommended study, in order to identify the position of the cecum to determine if the patient is malrotated. Unfortunately, the barium enema does not show whether a midgut volvulus is present.

An ultrasound examination can suggest the presence of malrotation, and can demonstrate the presence of midgut volvulus, but is not as sensitive for either as an upper GI exam.

References:
See References Chapter.

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