Neonate with Bilious vomiting Medical Question:

A 10 hour old girl has bilious emesis. She was born at 34 weeks gestation by vaginal delivery to a 24 year old woman who did not receive any prenatal care and used cocaine during her pregnancy. The infant has not had a bowel movement but has urinated. She was able to take a 2 bottle feeds by mouth but has been vomiting since the third feed. Birth weight was 2 kg (4 lb 6 oz), small for gestational age. Respirations are 39/min, Pulse 145/min and temperature 98.4F. The abdomen is distended and the skin is loose with diffuse lanugo. The rest of the examination is unremarkable. Abdominal radiograph is show. Which of the following is most likely the diagnosis.

A- Cocaine withdrawal
B- Hirschsprung’s disease
C- Duodenal atresia
D- Necrotizing Enterocolitis
E- Jejunal atresia
F- Pyloric stenosis

Neonate with Bilious vomiting.

Reference: USMLE world, LLC, Qbank ver 2009.02

[expand title=”CLICK HERE TO VIEW THE CORRECT ANSWER”][sociallocker]Correct answer is E. Jejunal atresia presents with Bilious vomiting and abdominal distention. The presence of “Triple Bubble” sing and gasless colon on abdominal x-ray reflects gas trapping in the stomach, duodenum and jejunum. Risk factors include prenatal exposure to cocaine and other vasoconstrictive drugs. Treatment should be focused initially on resuscitation and stabilization of the patient followed by surgical correction.[/sociallocker][/expand]