Approach to the baby with bilious vomiting

Published:November 17, 2021DOI:


      Bilious vomiting in the term neonate is a cardinal feature of a critical condition – intestinal malrotation – and may herald an impending abdominal crisis. It may also be due to a number of other surgical and medical causes, and there is a significant healthcare burden in excluding malrotation in the neonatal population. Health professionals caring for neonates need a sound knowledge of the assessment, diagnosis, and management of the neonate presenting with bilious vomiting. This review discusses the approach and immediate management, discusses uncertainties in evidence and offers practical advice for healthcare professionals who are faced with a baby with bilious vomiting.


      To read this article in full you will need to make a payment


        • Walker G.
        • Neilson A.
        • Young D.
        • Raine P.A.M.
        Colour of bile vomiting in intestinal obstruction in the newborn: questionnaire study.
        BMJ. 2006; 332: 1363
        • Zhang W.
        • Hongjun S.
        • Luo F.
        The efficiency of sonography in diagnosing volvulus in neonates with suspected intestinal malrotation.
        Medicine. 2017; 96: 42
        • Yousefzadeh D.
        The position of the duodenal jejunal junction: the wrong horse to bet on in diagnosing or excluding malrotation.
        Pediatr Radiol. 2009; 39: S172-S177
        • Ladd W.E.
        Congenital obstruction of the duodenum in children.
        N Engl J Med. 1931; 206: 277-283
        • Fawley J.
        • Abdelhafeez A.
        • Schultz J.
        • et al.
        The risk of midgut volvulus in patients with abdominal wall defects: a multi-institutional study.
        J pediatr surg. 2016; 52: 1 P26-P29

      Further reading

        • Bonasso II, P.C.
        • Dassinger III, S.
        • Smith S.D.
        Chapter 31 – malrotation.
        in: Holcomb III, G.W. Murphy J.P. Peter St., S.D. Holcolmb and Ashcraft's pediatric surgery. Elsevier, 2020: 507-516
        • Burge D.M.
        The management of bilious vomiting in the neonate.
        Early Hum Dev. 2016; 102: 41-45
        • Cullis P.S.
        • Mullan E.
        • Jackson A.
        • Walker G.
        An audit of bilious vomiting in term neonates referred for pediatric surgical assessment: can we reduce unnecessary transfers?.
        Jour Ped Surg. 2018; 53: 2123-2127
        • Malek M.M.
        • Randall S.B.
        Surgical treatment of malrotation after infancy: a population-based study.
        Jour Ped Surg. 2005; 40: 285-289
        • Metzger R.
        • Metzger U.
        • Fiegel H.C.
        • Kluth D.
        Embryology of the midgut.
        Semin Pediatr Surg. 2011; 20: 145-151