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Pediatric Imaging

E3048. The Vomiting Neonate: Embryology, Management, and Imaging

DiCamillo P1,  Rahim S1,  Weinert D2,  Vasavada P.1 1. University Hospitals Case Medical Center, Cleveland, OH; 2. Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL

Address correspondence to P. DiCamillo (paul@dicamillo.org)

Background Information: Neonatal vomiting is a common pediatric condition. A three-prong approach is taken to review this topic. The embryologic developmental basis of the condition is reviewed to set the stage. Then, a management framework is offered and explained. Finally, imaging findings in high intestinal obstruction are reviewed.

Educational Goals/Teaching Points: Teaching points in this exhibit will include a review of normal and abnormal embryologic development of the midgut, an outline for management of a neonate with a proximal small bowel obstruction, and a description of imaging findings of high intestinal obstruction in the neonate.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: The content of this exhibit is organized into four sections. First, we will cover differential diagnosis of the vomiting infant including structural causes, duodenal atresia, duodenal stenosis, duodenal web, jejunal atresia, jejunal stenosis, and malrotation. Second, we will cover embryologic development including stages of gut rotation and fixation, three basic patterns of bowel positioning, and complications of malrotation and malfixation. Third, we will review management options and prognosis (conservative management, laparoscopic intervention, and surgery). Fourth, we will review imaging findings on radiographs (abnormal proximal small bowel gas pattern, double bubble, and triple bubble) and upper GI examination (appearance of duodenal sweep, determination of position of duodenal jejunal junction, normal anatomic variations, and pitfalls) as well as the role of advanced imaging for mapping bowel positioning and the significance of cecal positioning abnormality.

Conclusion: Efficient evaluation, diagnosis, and treatment of high intestinal obstruction is a valuable clinical skill set and a key review topic for the radiology trainee.