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General Surgery

Answer 5

Figure 2

  1. Upper GI contrast study. Bilious emesis in an infant is considered an operative emergency until the potentially fatal diagnosis of midgut volvulus is ruled out.3 However, in the absence of indications for emergent therapy (eg, peritonitis, sepsis), an upper GI contrast study should be obtained to evaluate for disorders of intestinal rotation (Figure 2). Radiographs are often difficult to interpret and require evaluation by an experienced pediatric surgeon and a pediatric radiologist.4 Accurate diagnosis with prompt therapy can be lifesaving, while passive observation can be fatal. Abdominal ultrasonography is limited for detecting malrotations. If the patient is seriously ill with peritonitis such that an operation is felt to be unavoidable, immediate laparoscopy/laparotomy may be considered.

    3. Gosche JR, Vick L, Boulanger SC, Islam S. Midgut abnormalities. Surg Clin North Am 2006;86:285-99, viii.

    4. Applegate KE, Anderson JM, Klatte EC. Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series. Radiographics 2006;26:1485-500.

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