Approach to vomiting (newborn and infant) Quiz: Ace Your Exams

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A 10-month-old boy is brought to the emergency room for evaluation of one-day of vomiting and passing bloody stools. The parents report the patient was in his usual state of health until earlier in the day when he started vomiting, a green-colored emesis. The stools appear mucoid and look like “currant jelly.” The parents report the patient has been intermittently fussy. The patient was born full-term and has no significant past medical history. There are no known sick contacts, exposure to unusual foods, or new medications. Temperature is 37.2°C (98.9°F), pulse is 148/min, blood pressure is 85/48 mm Hg, respirations are 34/min, and oxygen saturation is 99% on room air. On physical examination, the patient is fussy, pale, and is lying supine with the knees pulled into the chest. The anterior fontanelle is open and flat. Cardiopulmonary examination is normal. The abdomen is nondistended, nontender, with normoactive bowel sounds. Which of the following is the best next step in management?

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Abdominal ultrasound

Upper gastrointestinal contrast study

Upper endoscopy

Abdominal magnetic resonance enterography (MRE)

Abdominal radiograph