Bilious Vomiting in 1st Week of Life

A BSTRACT Background: Neonatal bile vomiting may be the only related symptom to bowel obstruction (malrotation) that requires urgent surgical action to prevent long-term sequelae such as midgut gangrene or short gut syndrome. Methods: This was a retrospective audit of data over 4 years (between 2021 and 2025). We reviewed 73 neonates with bile vomiting at <7 days of age. Results: Seventy-three newborns (44 boys, 29 girls) were assessed for greenish vomiting during the audit period. Seventy-three percent of neonates had a suggestive result by plain X-ray. The most common definitive diagnosis was: bowel atresia ( n = 25), perforated viscus ( n = 10), necrotizing enterocolitis (NEC) ( n = 8). In total, 16 (22%) neonates received nonoperative treatment. 17 (23%) of cases were died. Conclusion: We noticed that there is a significant association between the presence of surgical pathologies and bile vomiting below 1 week. In this study, plain abdominal X-ray had an essential role in predicting diagnoses of bile vomiting in 1 st week of life. We noticed that the most common causes of bile vomiting below 1 week of life are bowel atresia, perforated viscus, NEC, and imperforate anus.