A 2 week old presents with multiple episodes of green vomiting today with inability to tolerate PO. Pt has had no fevers and normal birth history.
On exam, baby has a distended belly with moderate generalized tenderness.
What is the diagnosis?
malrotation with midgut volvulus
What is the pathophysiology of this disease?
During embryological development, the bowel fails to finish it’s rotation through the gut resulting in a small segment being held in place by a pedicle. The bowel can then twist around this pedicle, which can lead to bowel obstruction and ischemia.
How do you diagnose it and what is the name of this finding?
Abdominal X-ray shows double bubble sign. Images here. An upper GI series will show a “corkscrew sign” as seen here
What is the treatment for this disease?
NG tube, and surgery, though IV fluid and pain control could be considered.
By Dr. Andrew Grock and Dr. Sally Bogoch
Pediatric emergency medicine cpt 9
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