Differential Diagnosis for a 12-hour-old Female Newborn with Bilious Vomiting
- Single most likely diagnosis:
- Intestinal obstruction due to intestinal malrotation or volvulus. The clinical presentation of bilious vomiting in a newborn, along with a distended and firm abdomen and visible loops of intestine, strongly suggests an intestinal obstruction. The absence of stool on rectal examination and the presence of multiple dilated loops of small bowel on X-rays further support this diagnosis. Intestinal malrotation is a condition where the intestine does not properly rotate during development, which can lead to obstruction and volvulus (twisting of the intestine).
- Other Likely diagnoses:
- Hirschsprung's disease: This condition is characterized by the absence of ganglion cells in the distal bowel, leading to a functional obstruction. The abnormal caudal migration of ganglion cells through the alimentary tract (option A) is related to Hirschsprung's disease. However, the presence of bilious vomiting and the specific radiographic findings in this case make intestinal malrotation or volvulus more likely.
- Intestinal atresia: This is a congenital obstruction of the small intestine that can cause similar symptoms.
- Do Not Miss diagnoses:
- Midgut volvulus: This is a serious condition that can cause intestinal ischemia and necrosis if not promptly treated. It is often associated with intestinal malrotation.
- Necrotizing enterocolitis: Although more common in premature infants, this condition can occur in term infants and is a medical emergency.
- Rare diagnoses:
- Mesenteric infarction of a segment of small intestine (option E): This would be unusual in a newborn without a clear risk factor such as a cardiac condition leading to embolism.
- Failure of the omphalomesenteric duct to obliterate (option C): This condition can lead to various anomalies, including Meckel's diverticulum, but it is less likely to cause the acute presentation described.
- Abnormal pancreatic and intestinal gland secretions (option B): This is related to cystic fibrosis, which the sister has, but the clinical presentation and radiographic findings do not directly suggest cystic fibrosis as the primary cause of the newborn's condition.