Navigating Inconclusive Upper-Gastrointestinal Series in Infantile Bilious Vomiting: A Case Series on Intestinal...

Area of Science:

• Pediatric Surgery
• Diagnostic Imaging
• Neonatal Care

Background:

• Bilious vomiting in infants is a critical sign of potential intestinal malrotation with volvulus, requiring urgent surgical evaluation.
• The upper-gastrointestinal series (UGI) is the standard diagnostic tool, but up to 15% of studies yield inconclusive results, creating a diagnostic dilemma.

Observation:

• This case series details 3 infants with bilious vomiting and inconclusive initial UGI findings who were diagnosed with intestinal malrotation during surgery.
• Specific cases highlight challenges in visualizing the duodenojejunal flexure and distal small bowel on UGI, necessitating further investigation.

Findings:

• Adjunctive techniques, including modified UGI protocols and ultrasound, were successfully employed to achieve preoperative diagnoses of malrotation in these challenging cases.
• These methods helped overcome the limitations of standard UGI, providing crucial information for surgical planning.

Implications:

• Applying diagnostic adjuncts to inconclusive UGI studies can significantly enhance the preoperative diagnosis of intestinal malrotation in infants presenting with bilious vomiting.
• Improved diagnostic accuracy leads to timely surgical intervention, potentially improving outcomes for neonates with this serious condition.