What could be the possible cause of death in a 1-year-old child who presents with symptoms of vomiting, possibly bilious?

Possible Causes of Death in a 1-Year-Old Child with Bilious Vomiting

The most likely fatal cause of death in a 1-year-old child presenting with bilious vomiting is midgut volvulus leading to massive bowel necrosis and subsequent septic shock, cardiovascular collapse, and multi-organ failure. 1, 2

Life-Threatening Surgical Emergencies

Bilious vomiting at any age in infancy or childhood must be treated as a surgical emergency until proven otherwise. 3, 1, 2

Midgut Volvulus (Most Critical)

• Midgut volvulus represents the most time-sensitive diagnosis that can result in death if not recognized and treated emergently. 1
• This condition causes intestinal ischemia that rapidly progresses to bowel necrosis, leading to septic shock, metabolic acidosis, and death within hours if surgical intervention is delayed. 1, 2
• Malrotation with volvulus can present at any age during infancy, not just in the newborn period, making it relevant for a 1-year-old child. 3, 1

Intussusception

• Intussusception is another critical surgical cause that can present with bilious vomiting in a 1-year-old and lead to death from bowel necrosis and perforation. 1, 4
• This condition may initially present with only bilious vomiting before the classic triad of crampy pain and bloody "currant jelly" stools appears. 1, 4
• Delayed diagnosis results in bowel ischemia, perforation, peritonitis, sepsis, and death. 4

Other Life-Threatening Causes in This Age Group

Severe Dehydration and Metabolic Derangement

• Prolonged bilious vomiting can cause severe dehydration (≥10% fluid deficit), hypovolemic shock, and electrolyte abnormalities leading to cardiac arrest. 3, 2
• Metabolic acidosis, hypoglycemia, and electrolyte imbalances from persistent vomiting can be fatal if not corrected. 2

Sepsis and Meningitis

• Systemic infection presenting with vomiting can progress to septic shock, disseminated intravascular coagulation, and death. 2, 5
• Meningitis or encephalitis may present with vomiting and rapidly deteriorate to increased intracranial pressure, herniation, and death. 2

Metabolic Emergencies

• Inborn errors of metabolism can present with vomiting and lead to metabolic crisis, encephalopathy, cerebral edema, and death. 2
• Congenital adrenal hypoplasia causing adrenal crisis presents with vomiting, shock, and can be fatal without immediate steroid replacement. 2

Mechanism of Death in Bilious Vomiting

The pathway to death typically follows this sequence:

1. Intestinal obstruction with vascular compromise (volvulus, intussusception) → bowel ischemia → necrosis → perforation 1, 2, 4

2. Peritonitis and sepsis → systemic inflammatory response syndrome → septic shock → multi-organ failure 2

3. Severe dehydration → hypovolemic shock → inadequate tissue perfusion → cardiac arrest 3, 2

4. Metabolic derangements → severe acidosis, electrolyte abnormalities → cardiac arrhythmias → death 2

Critical Clinical Pearls

• Any infant or child with bilious vomiting requires immediate surgical consultation and imaging (upper GI series or ultrasound) to exclude malrotation with volvulus. 3, 1, 2
• The presence of bilious vomiting indicates obstruction distal to the ampulla of Vater and represents a red flag requiring urgent evaluation. 6, 3, 1
• Time is critical—delays in diagnosis of volvulus beyond 6-12 hours significantly increase the risk of massive bowel loss and death. 1, 2
• Even with normal vital signs initially, these surgical emergencies can deteriorate rapidly within hours. 1, 2