Neonatal bilious vomiting has a relatively narrow differential - those conditions that cause intestinal obstruction but do so distal to the ampulla of Vater. As such, the list includes:
- malrotation with midgut volvulus
- duodenal atresia
- jejunoileal atresia
- meconium ileus
- necrotizing enterocolitis
The cause of bilious vomiting in a neonate is malrotation with midgut volvulus until proven otherwise.
The first imaging of choice is a neonatal abdominal radiograph, followed by a neonatal upper GI contrast study looking for the position of the D-J flexure and the level of obstruction.
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