Question

A newborn baby is brought to the hospital with a complaint of persistent bilious vomiting soon after birth. The baby has passed meconium. The abdomen shows minimal distension and there is no palpable lump. The most probable diagnosis is

• A. Esophageal atresia
• B. Infantile pyloric stenosis
• C. Duodenal atresia
• D. Ileal atresia

Hint:

Match how early the vomiting starts and how little the abdomen is distended to how high up the obstruction must be.

Answer 1

The Correct Option is C

This question tests using the level of bowel obstruction to work out the diagnosis in a neonate with bilious vomiting.

1. Esophageal atresia: Presents with drooling and feeding-tube obstruction, and vomiting is not bilious since the block is above the bile duct opening.
2. Infantile pyloric stenosis: Presents weeks after birth with non-bilious projectile vomiting, since the obstruction lies before the ampulla of Vater.
3. Duodenal atresia: A high obstruction just past the ampulla, so vomiting is bilious and starts almost immediately, distension stays minimal because so little bowel lies above the block, and meconium can still pass normally.
4. Ileal atresia: A low obstruction that would cause marked distension and usually delayed meconium, which does not fit the minimal distension seen here.

Correct answer: Duodenal atresia.