Question
Which investigation would be the most suitable to diagnose the condition in a 3-day old neonate who is experiencing abdominal distention and bilious vomiting, out of the given options?
| A. |
CECT abdomen
|
| B. |
Barium meal
|
| C. |
Barium meal follow through
|
| D. |
Barium swallow
|
Show Answer
|
Correct Answer » B
Explanation
|
|
- Bilious vomiting in a 3-day-old neonate is a surgical emergency until proven otherwise.
- The most important diagnosis to exclude is intestinal malrotation with midgut volvulus, as delayed diagnosis can result in bowel ischemia and necrosis.
- The investigation of choice in a stable neonate with suspected malrotation is an Upper Gastrointestinal (UGI) contrast study (Barium meal or water-soluble contrast study).
Explanation of the Correct Answer
- Upper GI contrast study (Barium meal)evaluates:
- Position of the duodenojejunal (DJ) flexure.
- Course of the duodenum.
- Presence of a corkscrew appearance suggestive of midgut volvulus.
- It is considered the gold standard investigation for diagnosing intestinal malrotation.
Why Other Options are Incorrect
A. Contrast-enhanced computed tomography (CECT) abdomen
- Not the first-line investigation in neonates.
- Involves radiation exposure.
- Usually reserved for selected cases when the diagnosis remains uncertain or in older children.
C. Barium meal follow-through
- Evaluates the entire small intestine.
- Time-consuming and not preferred in an acutely ill neonate with suspected volvulus.
D. Barium swallow
- Evaluates the esophagus.
- Used for disorders such as esophageal atresia, tracheoesophageal fistula, or esophageal strictures.
- Does not assess intestinal malrotation.
