Paediatric Imaging

Vomiting

active and often forceful ejection of stomach contents via the mouth. Gastro oesophageal reflux in contrast is effortless regurgitation. Vomiting is a common symptom of many childhood illnesses, e.g. gastroenteritis, head injury, meningitis, subdural haematoma, brain tumour, pain, mesenteric adenitis, appendicitis and renal cystic disease, in addition to intestinal causes. These include gastric outlet obstruction as in hypertrophic pyloric stenosis and malrotation intestinal, atresia small intestine, bowel obstruction or a mass lesion in the epigastrium. If the cause of the vomiting is distal to the sphincter of Oddi, then the vomiting will be bile-stained. With more proximal causes, e.g. hypertrophic pyloric stenosis, the vomitus will be the gastric contents and not bile-stained. Bile-stained vomiting in children is always pathological and must be investigated. Gastric contents may be slightly yellow and this may be confused with bile.

The investigation of vomiting depends on the presumed cause and the age of the patient but in general should include a supine abdominal radiograph, supplemented by a decubitus film, abdominal ultrasound to assess the pylorus or suspected mass lesion, or water soluble upper gastrointestinal contrast studies if malrotation and volvulus are suspected.

HC