A 4-day-old term neonate vomits bile-stained material after every feed. Abdominal radiograph shows a 'double bubble' sign with minimal distal gas. Upper gastrointestinal contrast study demonstrates the duodenojejunal flexure to the right of the midline with a spiral ('corkscrew') course of the duodenum. After resuscitation, the definitive management is:

• A Duodenoduodenostomy
• B Contrast enema with pneumatic reduction
• C Heineke-Mikulicz pyloroplasty
• D Urgent Ladd's procedure ✓

Explanation

Bilious vomiting in a neonate with malrotation and midgut volvulus is a surgical emergency because the entire midgut is at risk of infarction around a narrow superior mesenteric vascular pedicle. After rapid resuscitation, an urgent Ladd's procedure is performed: derotation of the volvulus, division of Ladd's bands, widening of the mesentery, appendicectomy, and placement of the caecum in the left upper quadrant. Duodenoduodenostomy treats duodenal atresia, and enema reduction treats paediatric intussusception.

Reference: Nelson Textbook of Pediatrics, 22nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.