Green vomiting in the first 72 hours in normal infants
L. D. Lilien, G. Srinivasan, S. P. Pyati, T. F. Yeh and R. S. Pildes
From June 1980 to September 1984, forty-five newborns (weight greater than
or equal to 2000 g), initially presumed normal, were seen with bilious
vomiting in the first 72 hours and were prospectively followed up. Nine
(20%) required surgical intervention, five (11%) had nonsurgical
obstruction such as meconium plug or left microcolon, and the remaining 31
(69%) had idiopathic bilious vomiting. Infants with idiopathic bilious
vomiting had a benign transient course and resumed feedings by 1 week of
age; 30 of the 31 had normal or nonspecific findings on initial plain
abdominal roentgenogram. Specific findings on the initial plain abdominal
roentgenogram were noted in five infants, and four (80%) of these had a
lesion requiring surgical intervention; 56% (5/9) of neonates with surgical
lesions had normal or nonspecific findings on the plain abdominal
roentgenograms. None developed bowel ischemia or midgut infarction
secondary to a volvulus as they were identified by contrast studies shortly
after the initial episode of bilious vomiting. Although the majority of
"normal" neonates with bilious vomiting do not have a surgical lesion, this
study indicates that 56% of surgical cases will be missed if contrast
studies are not done.
