Can adults experience dark brown bilious vomiting?

Dark Brown Bilious Vomiting in Adults

Yes, dark brown bilious vomiting can occur in adults on some occasions, typically indicating the presence of bile mixed with gastric contents, which can result from various underlying conditions.

Causes of Bilious Vomiting in Adults

Obstructive Causes

• Small bowel obstruction - Can cause reflux of bile into the stomach with subsequent vomiting
• Post-surgical anatomy changes - Particularly after gastric surgeries that alter normal anatomy
• Malrotation with volvulus - Though more common in children, can occasionally present in adults

Non-obstructive Causes

• Bile reflux gastritis - Often occurs after gastric surgery or cholecystectomy 1
• Bile acid malabsorption - Can cause various gastrointestinal symptoms including vomiting 2, 3
• Functional disorders - Including recurrent vomiting syndrome 4

Clinical Significance and Evaluation

When to Be Concerned

• Bilious vomiting with acute onset should be considered a potential surgical emergency until proven otherwise 5, 6
• Chronic or recurrent bilious vomiting may indicate an underlying functional or anatomical disorder 4

Risk Factors to Consider

• Previous abdominal surgery - Particularly cholecystectomy (increases risk of bile reflux) 2
• History of inflammatory bowel disease - Especially with terminal ileal resection 2
• Radiation therapy to the abdomen or pelvis 2

Diagnostic Approach

Initial Assessment

• Determine if vomiting is acute or chronic
• Assess for signs of dehydration or electrolyte imbalances
• Evaluate for abdominal pain, distension, or other associated symptoms

Diagnostic Tests to Consider

• Abdominal imaging - X-ray or CT scan to evaluate for obstruction
• Upper endoscopy - To visualize bile reflux and assess for mucosal damage
• Hepatobiliary iminodiacetic acid (HIDA) scan - To evaluate bile flow
• SeHCAT scan - If bile acid malabsorption is suspected 2, 3

Management Strategies

Acute Management

• Fluid and electrolyte replacement - Critical in cases of persistent vomiting
• Nasogastric decompression - May provide symptomatic relief
• Surgical consultation - Urgent if obstruction is suspected

Chronic Management

• Bile acid sequestrants (cholestyramine, colestipol, colesevelam) - For bile acid malabsorption 2, 3
• Prokinetic agents - May help with gastric emptying
• Ursodeoxycholic acid - Has shown benefit in bile reflux gastritis 1
• Dietary modifications - Small, frequent meals low in fat

Important Considerations

• Bilious vomiting in adults is less commonly associated with life-threatening conditions compared to infants, but still warrants thorough evaluation
• The color of vomitus can range from yellow-green to dark brown depending on bile concentration and contact time with gastric acid
• Recurrent episodes may be associated with other functional disorders like migraine or irritable bowel syndrome 4
• Persistent symptoms despite appropriate management should prompt re-evaluation for missed diagnoses

Remember that while bilious vomiting in adults is often less emergent than in children, it still requires appropriate evaluation to identify the underlying cause and guide management.