Differential Diagnosis for Intermittent Bilious Emesis with Distention after NEC
- Single most likely diagnosis:
- Intussusception: This condition is a common cause of intestinal obstruction in infants, which can lead to bilious vomiting and abdominal distention, especially after a bout of necrotizing enterocolitis (NEC) that may have weakened the intestinal wall.
- Other Likely diagnoses:
- Adhesional bowel obstruction: After NEC, the formation of adhesions within the abdominal cavity can lead to bowel obstruction, causing symptoms like bilious vomiting and abdominal distention.
- Stricture: Narrowing of the intestinal lumen due to scarring from NEC can cause intermittent obstruction, leading to the described symptoms.
- Gastroesophageal reflux with pyloric stenosis: Although less common in the context of NEC, pyloric stenosis can cause projectile vomiting, and if the vomiting is bilious, it may indicate a more distal obstruction or other complications.
- Do Not Miss diagnoses:
- Volvulus: A twisting of a portion of the intestine that can cut off blood flow and lead to tissue death. It's a surgical emergency and can present with bilious vomiting and abdominal distention.
- Perforation: A hole in the wall of the intestine, which can lead to peritonitis, an infection of the abdominal cavity. This is a life-threatening condition requiring immediate surgical intervention.
- Rare diagnoses:
- Meconium ileus: Although more commonly associated with cystic fibrosis, it can cause intestinal obstruction in newborns, potentially leading to bilious vomiting if the obstruction is complete and involves the small intestine.
- Hirschsprung's disease: A congenital condition characterized by the absence of ganglion cells in the distal bowel, leading to functional obstruction. It typically presents in the neonatal period with failure to pass meconium, abdominal distention, and vomiting, which may be bilious if the obstruction is proximal enough.