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Malrotation with midgut volvulus — RACP Paediatrics MCQ

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HardNeonatologyMalrotation with midgut volvulusRACP Paediatrics

A 2-day-old term infant has repeated bilious vomiting and increasing abdominal distension. He passed meconium after birth but is now pale with intermittent tachycardia; abdominal radiograph is non-specific. What is the most appropriate investigation?

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Correct answer: B — Urgent upper gastrointestinal contrast study with surgical review

Bilious vomiting in a neonate is malrotation with volvulus until excluded, and urgent surgical review with an upper GI contrast study is appropriate if the infant is stable enough for imaging. Formula intolerance and reflux should not be considered before surgical obstruction has been excluded. The pearl is that a normal or non-specific abdominal radiograph does not rule out malrotation.

Reference: RCH Clinical Practice Guidelines: Acute abdominal pain; Therapeutic Guidelines (eTG)