Question:
A newborn presents with sudden onset bilious vomiting shortly after birth. Abdominal X-ray shows a double-bubble sign, but unlike classic duodenal atresia, there is also a gasless abdomen, raising concern for a surgical emergency. What is the most likely diagnosis?
A newborn presents with sudden onset bilious vomiting shortly after birth. Abdominal X-ray shows a double-bubble sign, but unlike classic duodenal atresia, there is also a gasless abdomen, raising concern for a surgical emergency. What is the most likely diagnosis?
Show Hint
Bilious vomiting in a neonate is Midgut Volvulus until proven otherwise by an Upper GI contrast study.
Time is bowel: Volvulus requires immediate emergent laparotomy (Ladd's procedure) to prevent complete midgut necrosis.
Time is bowel: Volvulus requires immediate emergent laparotomy (Ladd's procedure) to prevent complete midgut necrosis.
Updated On: Sep 3, 2026
- Duodenal atresia
- Jejunal atresia
- Malrotation with midgut volvulus
- Meconium ileus
Show Solution
Verified By Collegedunia
The Correct Option is C
Solution and Explanation
Concept:
The clinical scenario presents a newborn with sudden bilious vomiting and a specific variation of the "double-bubble" sign on an abdominal radiograph.
The clinician must recognize the critical difference between a congenital atresia and an acute vascular catastrophe of the bowel.
Explanation:
• Sudden onset bilious (green) vomiting in a neonate is the cardinal sign of an obstruction distal to the ampulla of Vater, and must be considered Malrotation with midgut volvulus until proven otherwise.
• A classic "double-bubble" sign on X-ray indicates an obstruction at the level of the duodenum (the two bubbles represent air in the stomach and the dilated proximal duodenum).
• While Duodenal Atresia is the most common cause of a double-bubble, it is a static, congenital condition usually presenting immediately on day one, and crucially, usually lacks any distal gas entirely from birth.
• However, if a neonate suddenly develops bilious vomiting after initially being well, and the X-ray shows a double-bubble but now with an acutely gasless distal abdomen, it indicates an acute, complete, catastrophic twist of the bowel.
• This twist is a Midgut Volvulus secondary to intestinal malrotation.
• The volvulus cuts off the superior mesenteric artery (SMA) blood supply to the entire midgut, causing rapid, irreversible bowel necrosis and death if not surgically untwisted (Ladd's procedure) within hours.
• Because it is an acute vascular emergency, this diagnosis must take precedence over static atresias when sudden clinical deterioration occurs.
Final Answer:
Sudden bilious vomiting with a double-bubble and gasless distal abdomen indicates an acute, life-threatening obstruction caused by Malrotation with midgut volvulus.
The clinical scenario presents a newborn with sudden bilious vomiting and a specific variation of the "double-bubble" sign on an abdominal radiograph.
The clinician must recognize the critical difference between a congenital atresia and an acute vascular catastrophe of the bowel.
Explanation:
• Sudden onset bilious (green) vomiting in a neonate is the cardinal sign of an obstruction distal to the ampulla of Vater, and must be considered Malrotation with midgut volvulus until proven otherwise.
• A classic "double-bubble" sign on X-ray indicates an obstruction at the level of the duodenum (the two bubbles represent air in the stomach and the dilated proximal duodenum).
• While Duodenal Atresia is the most common cause of a double-bubble, it is a static, congenital condition usually presenting immediately on day one, and crucially, usually lacks any distal gas entirely from birth.
• However, if a neonate suddenly develops bilious vomiting after initially being well, and the X-ray shows a double-bubble but now with an acutely gasless distal abdomen, it indicates an acute, complete, catastrophic twist of the bowel.
• This twist is a Midgut Volvulus secondary to intestinal malrotation.
• The volvulus cuts off the superior mesenteric artery (SMA) blood supply to the entire midgut, causing rapid, irreversible bowel necrosis and death if not surgically untwisted (Ladd's procedure) within hours.
• Because it is an acute vascular emergency, this diagnosis must take precedence over static atresias when sudden clinical deterioration occurs.
Final Answer:
Sudden bilious vomiting with a double-bubble and gasless distal abdomen indicates an acute, life-threatening obstruction caused by Malrotation with midgut volvulus.
Was this answer helpful?
0
0
Top NEET SS Surgical Questions
- A post-mastectomy patient (for malignant breast lump) who also had axillary lymph node dissection now presents in the postoperative period (after drain removal) with a soft, fluctuant swelling in the axilla extending into the mastectomy site.
- A patient presents with a large, multilobulated breast tumour clinically suggestive of phyllodes tumour, and there is a significant family history of breast cancer (grandmother) and prostate cancer (father). What is the next step in management?
- In a young woman with a breast lump confirmed on ultrasound to be a simple cyst, what is the next step in management?
- A 45-year-old woman underwent investigations for a breast lump. Her biopsy report confirms invasive ductal carcinoma of the breast. You are the surgical resident in charge and need to communicate the diagnosis to her. What is the most appropriate approach?
- A 35-year-old woman, a chronic smoker, presents with recurrent painful periareolar swelling and purulent nipple discharge for the past 6 months. She has undergone incision and drainage twice, but the symptoms recur after a short period. Which of the following statements about the most likely diagnosis is true?
View More Questions
Top NEET SS Basic Sciences as Applied to Pediatric Surgery Questions
- An 18-month-old male infant presents with recurrent episodes of colicky abdominal pain and crying, drawing up his legs during the attacks. Between episodes, he appears relatively well. Ultrasound of the abdomen shows a pseudo-kidney sign in the longitudinal axis. What is the most likely diagnosis?
- What is the most likely diagnosis?
- A 4-week-old male infant presents with progressively worsening non-bilious projectile vomiting, post-feed hunger, and visible left-to-right gastric peristalsis. What is the most likely diagnosis?
- A chest X-ray, with a gas-filled stomach visible. A newborn presents shortly after birth with excessive drooling, choking, and cyanosis on attempting feeds. What is the most likely diagnosis?
- A newborn male is noted at birth to have an absent anal opening. A diverting colostomy is performed, and a distal colostogram is shown. What is the most likely diagnosis?
View More Questions
Top NEET SS Questions
- A liver transplant patient presents with diarrhoea, colitis, a total leukocyte count of 1800, and a positive blood CMV PCR. What is the next step in management?
- A 32-year-old male recovering from dengue fever initially showed clinical improvement but now presents with recurrence of high-grade fever, fatigue, and pancytopenia on day 10 of illness. He is hemodynamically stable with no bleeding manifestations. Which of the following investigations should be performed first to evaluate the cause of relapse and cytopenia?
- A 48-year-old man with chronic hepatitis C infection is being evaluated for risk factors associated with progression of liver disease. He has a 20-year history of infection, drinks alcohol occasionally, and has a high serum HCV RNA viral load. Which of the following factors is not associated with an increased risk of progression of liver disease in chronic HCV infection?
- A 28-year-old veterinary worker who previously received a full 3-dose pre-exposure rabies vaccination series is bitten by a stray dog while handling an animal in the clinic. The wound is cleaned immediately. What is the most appropriate post-exposure management?
- A 42-year-old patient undergoing chemotherapy for acute myeloid leukemia develops neutropenia (ANC $<$ 500) and is treated with broad-spectrum antibiotics. After initial recovery of neutrophil counts (ANC = 1500), he again develops high-grade fever and right upper quadrant abdominal pain. Imaging shows multiple small hypodense lesions in the liver and spleen. What is the most likely diagnosis?
View More Questions