From the Guidelines
The recommended workup for a 2-month-old female with vomiting and abdominal distention should begin with a thorough history and physical examination, focusing on the timing and nature of vomiting, feeding patterns, stool characteristics, and growth parameters, as suggested by the American College of Radiology 1. Initial diagnostic tests should include abdominal radiographs to assess for obstruction or pneumoperitoneum, complete blood count, comprehensive metabolic panel, urinalysis, and stool studies. Abdominal ultrasound is valuable to evaluate for pyloric stenosis, malrotation, or intussusception, particularly in infants older than 2 weeks and up to 3 months old with new onset nonbilious vomiting, as recommended by Alazraki et al 1. The differential diagnosis includes:
- Pyloric stenosis (projectile vomiting, palpable olive-shaped mass)
- Intestinal malrotation with volvulus (bilious vomiting, acute distention)
- Intussusception (intermittent pain, currant jelly stools)
- Hirschsprung's disease (constipation since birth, distention)
- Gastroesophageal reflux disease (non-bilious vomiting after feeds)
- Milk protein allergy (vomiting, diarrhea, rash)
- Metabolic disorders (lethargy, poor feeding)
- Sepsis (fever, irritability) Urgent surgical consultation is necessary if bilious vomiting, pneumoperitoneum, or signs of bowel obstruction are present. Fluid resuscitation with isotonic fluids (10-20 mL/kg bolus if dehydrated) should be initiated promptly, followed by maintenance fluids, and nasogastric tube decompression may be needed for significant distention, as emphasized in the guidelines for vomiting in infants 1. Early recognition of surgical emergencies like malrotation with volvulus is critical as delays can lead to bowel ischemia and necrosis, significantly increasing morbidity and mortality in this vulnerable age group.
From the Research
Recommended Workup
The recommended workup for a 2-month-old female with vomiting and abdominal distention includes:
- Physical examination to assess for signs of dehydration, abdominal tenderness, and palpable masses
- Laboratory tests such as complete blood count, comprehensive metabolic panel, and stool studies with cultures to rule out infections and metabolic disorders 2
- Imaging studies such as abdominal radiography, ultrasonography, and computed tomography to evaluate for obstructive causes and other abdominal pathologies 2, 3
Differential Diagnosis
The differential diagnosis for a 2-month-old female with vomiting and abdominal distention includes:
- Hypertrophic pyloric stenosis (HPS), which can be diagnosed using ultrasonography and volumetric measurement of nasogastric aspirate 4, 3
- Gastroesophageal reflux (GER), which can be diagnosed using upper gastrointestinal series and pH probe studies 4, 3
- Infectious causes such as gastroenteritis, which can be diagnosed using stool studies and cultures 2
- Other obstructive causes such as intestinal obstruction or volvulus, which can be diagnosed using imaging studies and surgical exploration 2
- Eosinophilic gastroenteritis, which can be diagnosed using endoscopy and biopsy 5
- Other medical causes such as metabolic disorders, endocrine conditions, and central nervous system disorders, which can be diagnosed using laboratory tests and imaging studies 2