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Malrotation with volvulus — RACP Paediatrics MCQ

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HardNeonatologyMalrotation with volvulusRACP Paediatrics

A 3-day-old term infant has sudden bile-stained vomiting and becomes pale between episodes. The abdomen is not markedly distended and the rectum is empty. Abdominal radiograph is non-specific, with little distal bowel gas. What is the most likely diagnosis?

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Correct answer: D — Malrotation with midgut volvulus

Bilious vomiting in a neonate is intestinal obstruction until proven otherwise, and the intermittent pallor raises concern for volvulus. Pyloric stenosis usually presents later with non-bilious vomiting. Surgical review and urgent upper gastrointestinal contrast imaging are needed if the infant is stable enough.

Reference: RCH Vomiting guideline; RACP Knowledge Guides