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Malrotation with volvulus — RACP Paediatrics MCQ

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ModerateGIMalrotation with volvulusRACP Paediatrics

A 3-day-old neonate presents with bilious vomiting and abdominal distension. The baby had passed meconium normally. Abdominal X-ray shows a 'double bubble' sign with distal gas. The baby suddenly becomes pale and shocked. What is the most likely diagnosis?

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Correct answer: D — Malrotation with volvulus

Bilious vomiting in a neonate is malrotation with volvulus until proven otherwise. A double bubble with distal gas (incomplete obstruction) and acute circulatory compromise suggests midgut volvulus causing bowel ischaemia. This is a surgical emergency requiring immediate Ladd procedure. An upper GI contrast study should not delay surgery if the diagnosis is clinically apparent.

Reference: RCH Melbourne – 2023 – Bilious Vomiting CPG; RACP Paediatric Curriculum – Gastroenterology