Bilious vomiting

Introduction

Bilious vomiting is when a baby’s vomit is green or yellow. Green or yellow colour is caused by bile, which is a fluid made by the liver. 

Bile in the vomit is usually caused by a blockage or twisting in the intestine or bowel. The intestines and bowel are organs in the digestive system that process food and remove waste from the body as poo. 

A blockage or twist can stop blood from getting to the organs, causing serious damage and organ death.  Blockage or twisting of the intestines or bowel is a medical emergency and can be life-threatening 

Babies with blocked or twisted bowels can appear healthy, even as the bowel is being damaged.  

The most important sign of a blocked or twisted bowel is bilious vomit, which is when the vomit is green or yellow. 

If your baby’s vomit is green or yellow, call triple zero (000) for an ambulance or go to your nearest emergency department. 

If your baby is in hospital, let your doctor, nurse, or midwife know as soon as possible. 

If your baby has a feeding tube in their stomach, and they are having trouble with feeds, they may need a gastric residual aspirate.  

A gastric residual aspirate is when a tube is inserted into the nose or mouth to remove liquid from the stomach. If the liquid is bright green or yellow, it is called a bilious aspirate. This can also be caused by a twist or blockage of the intestine or bowel. 

Your baby will be checked by a doctor and nurse who will do some tests and scans to find out whether there is a twist or blockage in the bowel. 

A contrast X-ray will be done to see if the bowel is: 

• twisted – also called a volvulus 
• sitting in the wrong position – also called a malrotation. 

Your baby’s doctor may order some other tests, including blood tests, to make sure the bilious vomit is not caused by something else. 

If your baby has a malrotation or volvulus, they will need urgent transfer to a children’s hospital for emergency surgery. 

If the contrast x-ray is normal, your baby can be transferred back to your local hospital. 

The first step in treating bilious vomiting is to stop feeding your baby. This will let their bowel rest and prevent further vomiting. 

In the hospital, your baby will have an intravenous (IV) cannula put in their arm so they can have fluid and sugar while they are not eating. 

Your baby’s doctor may also give them antibiotics in case the vomiting has been caused by an infection. 

Your baby can start feeds again once their doctor has confirmed there is no twist or blockage. 

If there is a blockage or twist, your baby will need emergency surgery. The surgery will untwist the bowel, repair the blood supply, and secure the bowel in a normal position. 

Causes of bilious vomiting 

Bilious vomiting can be caused by:  

• infection 
• birth defects in the bowel 
• blockage by meconium – your baby’s first poo 
• the formation of a hole in the bowel, also called a perforation 
• gastroesophageal reflux.