A 24 hour old baby that was born at term presents with bile stained vomiting. The baby has been bottle fed but it is not feeding well. On examination the baby was noted to have a distended abdomen. An abdominal x-ray was performed:
The abdominal x-ray.
Q1. What is the diagnosis.
Small bowel atresia / small bowel obstruction.
The x-ray shows the gas filled stomach with a grossly dilated duodenum. There are also a few more loops of dilated small bowel seen "superimposed" on the dilated duodenum. There is no colonic gas (no gas seen in the lower abdomen / pelvis). This suggests that there is a blockage in the small bowel and nothing has been able to pass into the colon. A neonate presenting with bilious vomiting is very suspicious of some form of bowel obstruction. In this case there was a small bowel atresia. Atresia of the small bowel is thought to mainly occur due to interruption of the vascular supply to that area of the bowel whilst in utero.
