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Child Is Vomiting And Have Abdominal Pain. All Test Normal, OGD Shows Dilation Of Duodenum. Cause?

Posted on Wed, 9 Oct 2013

Question: My daughter is 11 years old with vomiting aand abdominal pain symptoms since 2 years, all blood tests, and CT abd, and endoscalso done, everything seems to be normal except that the OGD shows dilatation of duodenum , but docs said that its normal, but now again she had same episode, thay are considering it to be cyclic vomiting syndrome but also asked me to do a barium meal test, since her last episode had biluous vomiting and abdominal pain.... please let me know what the problem they may be suspecting or is it CVS?

Answered by Dr. Arun (1 hour later)

Brief Answer:
Bilious vomiting indicates intestinal obstruction.

Detailed Answer:
Hi
Thanks for writing to Healthcare magic.
From what you described your child had bilious vomiting which NEEDS definitive workup by a pediatric surgeon including barium study. I think your doctor has rightly done so . Bilious vomiting can be due to many causes like intestinal obstruction beyond 2nd part of duodenum, worms, inflammatory bowel disease, etc
Do not worry, your barium meal should give information on these obstructive causes if present.
If it is negative and your kid doesnot have any further bilious vomiting , then it is most likey cyclic vomiting which can improve with drugs like propranolol. But it needs to prescribed under supervision only if other problems are ruled out
I hope I have answered your query
Wishing your daughter good recovery soon
Regards
Dr Arun

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Arun (36 minutes later)

Thanks for ur answer, as of now she is taking Practin (Cyproheptadine dailly) once after meal, considering it should be Cyclic Vomiting Syndrome, My one query is , hoping that the barium turns out to be normal, if not does all minor intestinal obstruction need surgery? and in Cyclic vomiting syndrome is biluous vomiting and abdominal pain a common symptom?

thanks

Answered by Dr. Arun (33 minutes later)

Brief Answer:
Bilious vomiting can occur in CVS

Detailed Answer:
Hi
Bilious vomiting can occur in CVS.
But it needs careful workup which is being done in your kid
Apart from this do get amylase lipase, ALT/GGT tests done DURING vomiting attacks to rule out mild intermittent pancreatitis.
Obstructions need to be treated surgically ( laproscopic minimally invasive as far as possible) but not always, it depends on the location, degree of obstruction and bowel perfusion status and so on
Regards
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Arun (2 hours later)

thanks for the answer, As per her endoscopy, in her report it is mention that everything is normal except that the duodenal lumen is dilated, and unexplained, is this a normal thing during vomiting, etc,

regards XXXXXXX

Answered by Dr. Arun (5 minutes later)

Hi
As per your query dilatation of duodenum with bilious vomiting is usually indicative some obstruction below the second part of duodenum.
The cause and site may be identified by barium meal
Regards
Dr Arun

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar