Is green vomit ever normal?
A 3-day-old term baby who had been feeding well suddenly vomits dark green fluid several times. Their tummy is soft and not swollen, and they otherwise look well.
Which diagnosis must be ruled out urgently, and how?
Pick the diagnosis
Need a clue?
Green vomit means bile. Bile enters in the second part of the duodenum, so the blockage must be below that point.
Show the answer
Malrotation with midgut volvulus
- What's going on
- Before birth the gut rotates and fixes in place. In malrotation this goes wrong, leaving the small bowel on a narrow stalk that can twist (volvulus) and cut off its own blood supply.
- Spot it
- Dark green (bilious) vomiting in a newborn. The tummy can look completely normal early on.
- Test
- Upper GI contrast study. A plain X-ray can't rule it out.
- Treatment
- Emergency Ladd's procedure: untwist the bowel, divide Ladd's bands and widen the base of the mesentery. The appendix is often removed too, because it ends up on the left, where appendicitis would be missed.
- Why it matters
- Green vomit in a newborn is a surgical emergency until proven otherwise. Delay can mean losing the bowel.
Go further
Tap a question to check your answer.
What does green vomit tell you?
It's bile, so the blockage is below where bile enters the duodenum.
What could block the bowel that suddenly?
Malrotation: the bowel can twist on itself (volvulus).
Why is it an emergency?
The twisted bowel cuts off its own blood supply. Hours count.
What test do you want?
An upper GI contrast study. A plain X-ray can't rule it out.
Harder: what's the operation?
Ladd's procedure: untwist, divide Ladd's bands, widen the mesentery.
Source: BAPM bilious vomiting framework ยท Radiopaedia
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