Assessment of a Vomiting Four-Day-Old Child

Paper Summary:

This paper discusses that the differential diagnosis for a vomiting four-day-old child is extensive, including intestinal obstructions, inborn errors of metabolism, sepsis, intracranial bleeding, gastroenteritis, and overfeeding. The author concludes that imaging diagnosis suggests malrotation of the small intestine, resulting in partial obstruction of the small bowel. The paper relates that the prognosis for children who undergo surgery before development of any degree of bowel infarction usually can return to normal function within three days.

Table of Contents
General Information
Chief Complaint
History of the Present Illness
Family History
Review of Systems
Social History
Physical Examination
Clinical Laboratory
Differential Diagnosis
Assessment
Treatment plan
Discussion

From the Paper:

"Imaging studies were obtained. Abdominal radiographs were essentially unremarkable. An upper GI series was obtained and showed that the duodenal-jejunal junction was abnormally located to the right of the patient's spine. After this point there was a narrowing of the duodenum with a fine thread of contrast extending inferiorly in a "corkscrew" like appearance. Abdominal ultrasound with color Doppler was also obtained and shows the superior mesenteric vein coursing around the superior mesenteric artery in a swirl-like appearance."

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