An expert on paediatric intestinal obstruction, Prof. Gohary Amin, says children who develop bilious vomiting should be considered as having an underlying intestinal obstruction except a test proves otherwise.
Among pregnant women, if ultrasound scan detects a foetus as having intestinal abnormality, the woman will be referred to a paediatric surgeon so that as soon as the baby is born, he could be operated on within six hours.
According to American Academy of Paediatrics, bilious vomiting occurs when bile is purged along with the gastric contents; while Mayo Clinic describes intestinal obstruction as a blockage that keeps food or liquid from passing through the small intestine or large intestine (colon).
In a publication titled ‘Paediatric intestinal obstruction’ posted on Global Journal of Digestive Diseases late September, Amin said vomiting in children was common and mostly related to a medical condition.
“However, there are surgical conditions associated with vomiting which needs to be acknowledged and diagnosed early.
“Bilious vomiting is an ominous symptom and needs to be taken seriously.
“Any baby who vomits bile should be considered as having an underlying intestinal obstruction until proved otherwise,” he said.
Dr. Amin is well known in Abu Dhabi for his extensive interest and involvement in scientific activities. He is also president of Paediatric Surgical Association of UAE and founder of Arab Association of Paediatric Surgeons.
Also speaking on the condition, Consultant Paediatrician at Emel Hospital, Lagos, Dr. Ngozi Ulonnam, said vomiting of bile was not a strange occurrence in children.
“It is a situation where a child vomits greenish materials. Normally, bile is part of the digestive system and everything is expected to flow downward and excreted.
“It shows there is an obstruction. There is something blocking the digested food from moving down.
“The obstruction causes discomfort and sends a trigger to the brain. The result could come in form of bilious vomiting,” Dr. Ulonnam said.
She noted that intestinal obstruction was quite common, especially among babies who are born with congenital abnormalities where they have the congenital obstruction.
She urged parents nursing babies to be vigilant, adding that they should not hesitate to visit the hospital for evaluation if their babies start vomiting ‘greenish materials.’
“It is an emergency. The longer the obstruction remains, the bowels begin to die. If care is not taken, the patient’s chances of survival may be slim,” the physician said.
Another thing to note is that children who have had surgery in the past are more at risk of intestinal obstruction. “Due to the fact that the bowels had been touched, it can obstruct again,” Ulonnam stated.
Another Consultant Paediatrician at Gbagada General Hospital, Lagos, Dr. Emokpae Abieyuwa, said bilious vomiting may occur when there is an obstruction in the gallbladder (which houses the bile) and the intestines.
He emphasized that until proven otherwise, an intestinal obstruction should be suspected where vomiting of bile takes place.
“Normally, when you eat, it starts digesting in the mouth and passes through the stomach. Then it moves to the small and large intestines before the remnants come out as faeces.
“Where there is an obstruction, that process will not take place, depending on the area it occurs.
“The end result is that the patient will find it very difficult to pass stool. Usually, it presents in the form of vomiting, constipation and abdominal distention,” Abieyuwa said.
According to Wiki, abdominal distension occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its expansion.
It is typically a symptom of an underlying disease or dysfunction in the body, rather than an illness in its own right.
Continuing, Abieyuwa said, “Depending on the age, it is a frequent emergency we get to see daily in teaching hospitals across the country. Some children born with it tends to develop big abdomen. That’s how we get to assess if it is intestinal obstruction.
“Once the abdomen is big, we send for an X-ray. Once the result shows it is obstruction, we have to quickly take the child in for surgery. The more we delay, the more the complications that can come up.”
According to the paediatrician, when compared with general diseases, one may not immediately see the problem as frequent.
“But if you view it from the point of emergency surgeries, you will understand that it is a common feature among paediatric patients.
“With the level of ultrasound scan, intestinal abnormality can now be diagnosed in pregnancy.
“Once detected, the woman can be referred to a paediatric surgeon so that as soon as the baby is born, he could be operated within six hours,” he noted.
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