Prathap S1
AIM
Bilious vomiting in neonates and infants is usually due to intestinal obstruction. But we have found that some cases of yellowish vomiting in such babies are not due to intestinal obstruction as evidenced by a Barium meal X-ray series. They seem to have a partial folding of the stomach fundus with horizontal lie of the stomach leading to increased duodeno-gastric reflux which causes the yellowish vomiting. For this pathology, a simple nonsurgical method is sufficient to relieve the patient of his symptoms. This study aims at popularizing this method of management in those select babies who have symptoms but no evidence of surgical emergency.
SETTINGS AND DESIGN
This is a prospective study where all babies who presented with bilious vomiting were evaluated completely. The primary mode of identifying the pathology was Barium meal X-ray study. Those babies with no evidence of intestinal obstruction were included in this study. The pathology of the stomach in these babies were identified and management was offered by positioning technique; they were evaluated after one week, one month, three months, six months, one year and every year upto 4 years of age.
RESULTS
During the six year study, 263 neonates and infants had presented to the Pediatric Surgery OPD with bilious vomiting. Of these 263 patients, 96 babies had no radiological features to diagnose intestinal obstruction. These 96 babies were included in this study. All the babies were admitted and nursed in the prone propped up position on bed continuously. The caregivers of the babies were instructed to do so after discharge from hospital. All the 96 babies responded favorably to this management during the two day admission as in-patients.
Of the 96 patients, 85 of them were followed up by regular OPD visits and telephonic contact, 11 were lost to follow up. Of the 85 patients, 82(96.47%) had complete resolution of symptoms. The caregivers of 3 of the babies did not seem satisfied with this mode of management and preferred to go to some other centre after a few days to a few weeks of treatment. The body weights of the 82 patients were assessed and adequate growth was recorded.
SAMPLE SIZE
263 babies who presented with bilious vomiting were evaluated during this six year period. 96 babies with no features of intestinal obstruction were taken as study group.
STUDY AREA
This study was conducted in the Department Of Pediatric Surgery at Government Medical College, Thiruvananthapuram and Kozhikode, Kerala state, South India.
