A 3-Day-Old Boy With Bilious Emesis

Jamie Shalkow, MD


April 14, 2016

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A 3-day-old East African baby boy is brought to the emergency department (ED) by his parents with a 2-day history of feeding intolerance and persistent vomiting of green fluid. Both parents are farmers, and the patient has five older siblings, all without any known medical conditions. He was born full-term at 39 weeks' gestation; however, he was small for his gestational age, measuring 18.1 in (46 cm) and weighing 4.6 lb (2.1 kg).

The patient's prenatal history is noncontributory, but it is notable that no antenatal ultrasonography to check for physical, physiologic, or amniotic fluid abnormalities was performed. The patient was delivered vaginally at home without any complications. He initially tolerated breastfeeding well and passed meconium during the first day of life.

Since the second day of life, he has not tolerated breastfeeding and has been vomiting recurrently. Initially, the emesis consisted of ingested milk and would occur approximately 30 minutes after having a meal. Subsequently, the vomiting became green, more profuse, and would start only 10 minutes after being fed. On the day of presentation, the vomiting is more frequent and occurs even without oral intake. In addition, he has not passed any stool for the past 24 hours.


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