Differentials
Duodenal atresia/web
SIGNS / SYMPTOMS
Duodenal atresia is usually not associated with abdominal pain, physiologic perturbation, or metabolic acidosis. Any of these signs should press urgent action toward diagnosis and treatment of volvulus.
INVESTIGATIONS
On plain film radiography in a newborn with bilious vomiting, the presence of bowel gas beyond the duodenum suggests either midgut volvulus or type 1 duodenal atresia; therefore, an upper gastrointestinal series should be done to differentiate between them.
Intussusception
SIGNS / SYMPTOMS
The incidence of intussusception increases sharply at 5 months when volvulus is beginning to decrease in incidence.
Bilious vomiting is delayed or secondary if present at all in the presentation of intussusception as opposed to volvulus.
Intussusception is typically distinguished by periods of sudden abdominal pain followed by complete cessation. These continue to return as equally sharp in waves, until the intussusception is reduced.
INVESTIGATIONS
Ultrasound identifies intussusception in most cases.
Contrast enema (with air or barium) is thereafter used to confirm the diagnosis and reduce the intussusceptum.
Gastroesophageal reflux
SIGNS / SYMPTOMS
Malrotation without volvulus may cause intermittent nonbilious vomiting that appears identical to reflux, and the two cannot be distinguished by history or physical exam.
INVESTIGATIONS
Upper gastrointestinal contrast series definitively clarifies malrotation.
Nonspecific symptoms
SIGNS / SYMPTOMS
It is important to consider that malrotation without volvulus is diagnosed for a wide variety of complaints that lead to a contrast study, including diarrhea, constipation, anorexia, irritability, apnea, lethargy, failure to thrive, blood in stool, and fever.[11]
INVESTIGATIONS
Upper gastrointestinal contrast series definitively clarifies malrotation.
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