Case of the Month April 2015, Page 2

The initial imaging test depends largely on the age and clinical presentation of the patient.  Bilious vomiting in a neonate should raise suspicion for a congenital abnormality, and as such fluoroscopic studies play in a large role.  Intermittent non-bilious vomiting since birth adds pyloric stenosis to the differential, which can be well evaluated by ultrasound.  In most cases, including this one, a plain radiograph is an appropriate initial test to guide further investigation.

For larger images, please click on Ardestani 1 and Ardestani 2





The plain films (scout images from a fluoroscopic study) showed a non-specific, non-obstructive bowel gas pattern, with a relative paucity of bowel gas in the left hemi-abdomen.  It is important to note that a lateral cross-table view was also obtained for detection of any extraluminal gas (not present).  An upper-GI series was performed.

For a larger image, please click on Ardestani 3 .


An upper-GI series showed the above findings.  Where is the normal position of the Ligament of Treitz?


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