Paediatric, Vomiting
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Population Covered By The Guidance
This pathway provides guidance on the imaging of paediatric patients with recurrent vomiting of uncertain aetiology.
Date reviewed: July 2014
Date of next review: July 2023
Published: July 2014
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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| 1 |  |
Malrotation Image 1 (Upper GI Contrast Study): There is a spiral or corkscrew appearance of the lower duodenum and proximal jejunum consistent with malrotation. |
| 2a |  |
Hypertrophic Pyloric Stenosis Image 2a and b (Ultrasound): The pylorus is enlarged, measuring 22mm in length, 13mm in width and the muscle thickness is almost 5mm. The appearance is consistent with significant hypertrophic pyloric stenosis. |
| 2b |  |
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Teaching Points
Teaching Points
- The character of the vomitus and the relationship to meals should be determined. A thorough clinical history and examination should be performed
- Infants with bilious vomiting should be considered to have intestinal obstruction. Plain radiography and an upper GI contrast study should be considered
- Infants with non-bilious vomiting and suspected of having hypertrophic pyloric stenosis, should undergo ultrasonography
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Papdakis K, Chen EA, Luks FI, et al. The changing presentation of pyloric stenosis. Am J Emerg Med. 1999;17:67-9. (Level III evidence)
- Gibbs MK, Van Herrden JA, Lynn HB. Congenital Hypertrophic pyloric stenosis. Surgical experience. Mayo Clin Proc 1975;50:312-6. (Level IV evidence)
- Hernanz-Schulman M, Sells LL, Ambrosino MM, et al. Hypertrophic pyloric stenosis in the infant without a palpable olive: accuracy of sonographic diagnosis. Radiology. 1994;193:771-6. (Level IV evidence)
- Strouse PJ. Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol. 2004;34:837-51. (Review article)
- McAlister WH, Kronemer KA. Emergency gastrointestinal radiology of the newborn. Radiol Clinic North Am. 1996;34:819-44. (Review article)
- Hernanz-Schulman M. Infantile hypertrophic pyloric stenosis. Radiology. 2003;227:319-31. (Review article)
- Stunden RJ, LeQuesne GW, Little KE. The improved ultrasound diagnosis of hypertrophic pyloric stenosis. Pediatr Radiol. 1986;16:200-5. (Level II evidence). View the reference
- Wilson DA, Vanhoutte JJ. The reliable sonographic diagnosis of hypertrophic pyloric stenosis. J Clin Ultrasound. 1984;12:201-4. (Level IV evidence)
- Cohen HL, Zinn HL, Haller JO, et al. Ultrasonography of pylorospasm: findings may simulate hypertrophic pyloric stenosis. J Ultrasound Med. 1998;17:705-11. (Level III evidence)
- Haller JO, Cohen HL Hypertrophic pyloric stenosis: diagnosis using US. Radiology. 1986;161:335-9. (Review article)
- O'Keeffe FN, Stansberry SD, Swischuk LE, Hayden CK Jr. Antropyloric muscle thickness at US in infants: what is normal? Radiology. 1991;178:827-30. (Level III evidence)
- Zerin JM, DiPietro MA. Superior mesenteric vascular anatomy at US in patients with surgically proved malrotation of the midgut. Radiology. 1992;183:693-4. (Level III evidence)
- Dufour D, Delaet MH, Dassonville M, Cadranel S, Perlmutter N. Midgut malrotation, the reliability of sonographic diagnosis. Pediatr Radiol. 1992;22:21-23. (Level III evidence)
- Shimmanuki Y, Aihara T, Takano H, et al. Clockwise whirlpool sign at color Doppler US: an objective and definite sign of midgut volvulus. Radiology. 1996;199:261-4. (Level III/IV evidence)
- Hayden CK, Boulden TF, Swischuk LE, Lobe TE. Sonographic demonstration of duodenal obstruction with midgut volvulus. AJR Am J Roentgenol. 1984;143:9-10. (Level IV evidence)
- Weinberger E, Winters WD, Liddell RM, Rosenbaum DM, Krauter D. Sonographic diagnosis of intestinal malrotation in infants: importance of the relative positions of the superior mesenteric vein and artery. AJR Am J Roentgenol. 1992;159:825-8. (Level III evidence)
- Buonomo C. Neonatal gastrointestinal emergencies. Radiol Clin North Am. 1997;35:845-64. (Review article)
- Jolley SG. Gastroesophageal reflux disease as a cause for emesis in infants. Semin Pediatr Surg. 2005;4:176-89. (Review article)
- Alford BA, McIlhenny J. The child with acute abdominal pain and vomiting. Radiol Clin North Am. 1992;30:441-53. (Review article)
- Torres AM, Ziegler MM. Malrotation of the intestine. World J Surg. 1993;17:326-31. (Level III evidence). View the reference
- Al-Khawari HA, Sinan TS, Seymour H. Diagnosis of gastro-oesophageal reflux in children. Comparison between oesophageal pH and barium examinations. Pediatr Radiol. 2002;32:765-70. (Level IV evidence)
- Seibert JJ, Byrne WJ, Euler AR, Latture T, Leach M, Campbell M. Gastroesophageal reflux - the acid test: scintigraphy or the pH probe. AJR Am J Roentgenol. 1983;140:1087-90. (Level III evidence). View the reference
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
Consent to Procedure or Treatment Radiation Risks of X-rays and Scans |
Radiation Risk of Medical Imaging for Adults and Children Paediatric Abdominal Ultrasound Children's (Paediatric) X-ray Examination |
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