Paediatric surgery: malrotation with volvulus: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Paediatric surgery: malrotation with volvulus

Sample item

A 5-day-old, previously well, haemodynamically stable neonate has sudden bilious vomiting. The abdomen is soft and not distended. Which investigation should be done urgently?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Upper gastrointestinal contrast study

Bilious vomiting in a neonate is malrotation with midgut volvulus until proved otherwise, because delay risks total midgut infarction. In a stable infant, an upper GI contrast study shows an abnormal duodenojejunal flexure to the right of the midline or a corkscrew duodenum. If shocked or peritonitic, the infant goes directly to theatre for a Ladd procedure.

Option by option

  • A. Upper gastrointestinal contrast study (correct)

    Correct. It shows the position of the duodenojejunal flexure and a spiral duodenum.

  • B. Abdominal ultrasound for pyloric thickness

    Pyloric stenosis causes non-bilious vomiting at several weeks of age.

  • C. Barium enema

    Barium enema may show a misplaced caecum but is less reliable.

  • D. Sweat chloride test

    A sweat test is irrelevant to acute bilious vomiting.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Upper gastrointestinal contrast study. Bilious vomiting in a neonate is malrotation with midgut volvulus until proved otherwise, because delay risks total midgut infarction.

Why is "Abdominal ultrasound for pyloric thickness" not the answer?

Pyloric stenosis causes non-bilious vomiting at several weeks of age.

Why is "Barium enema" not the answer?

Barium enema may show a misplaced caecum but is less reliable.

Why is "Sweat chloride test" not the answer?

A sweat test is irrelevant to acute bilious vomiting.

What concept does this question test?

It tests Paediatric surgery: malrotation with volvulus in General Surgery. In a stable infant, an upper GI contrast study shows an abnormal duodenojejunal flexure to the right of the midline or a corkscrew duodenum. If shocked or peritonitic, the infant goes directly to theatre for a Ladd procedure.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric surgery: malrotation with volvulus?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.