ORIGINAL ARTICLE Chronic bilious vomiting in children in developing countries due to high bowel obstruction: not always malrotation or tuberculosis Anand Pandey • V. Kumar • A. N. Gangopadhyay • S. P. Sharma • S. C. Gopal • D. K. Gupta • S. C. U. Patne Accepted: 26 October 2009 / Published online: 13 November 2009 Ó Springer-Verlag 2009 Abstract Background Bilious vomiting, in conjunction with abdominal pain is considered to be a surgical problem, unless proved otherwise. In children, besides tuberculosis (TB), we have found jejunal stricture (JS) due to non- specific jejunoileitis (NSJI) to be an important cause of chronic high small bowel obstruction and bilious vomiting. Materials and methods In this retrospective study, the records of all children with complaint of intermittent bil- ious vomiting and failure to thrive were evaluated. Inves- tigations included oral contrast study, ultrasound abdomen, chest X-ray and Mantoux test. Final confirmation was made at laparotomy. Treatment included jejuno-jejunal resection and anastomosis. Histopathology of the specimen was done to look for caseation, granuloma formation and other details. Results Out of total 100 patients with the complaint of bilious vomiting, 25 were having JS. Radiologic confir- mation was possible in 19 (76%) patients of JS. No patient had evidence of TB as per our protocol. Histopathology revealed non-specific ischemic changes in all specimens. Conclusion Jejunal stricture due to NSJI is a common entity in our setup leading to bilious vomiting. Contrast study can provide high index of suspicion in most of the patients. The diagnosis must be confirmed after proper histopathological examination. The results of the surgery are excellent. Keywords Jejunal stricture Á Ischemic enteritis Á Jejunoileitis Á Non-specific jejunoileitis Introduction Bilious vomiting is always a concern because of its asso- ciation with surgical etiology. Bilious vomiting, in con- junction with abdominal pain is considered to be a surgical problem, unless proved otherwise [1]. In neonatal period, this vomiting is due to high small bowel obstruction resulting from atresia, stenosis and malrotation, etc. [2]. Vomiting, especially in older children, i.e. beyond infancy have other reasons when compared with neonates. In developing countries such as India, tuberculosis (TB) is an important cause of bowel obstruction and bilious vom- iting in children. We have, however, found jejunal stricture (JS) due to non-specific jejunoileitis (NSJI) to be an important cause of chronic high small bowel obstruction and bilious vomiting. There have been various studies on jejunoileitis, but JS as a sequel to NSJI has not been evaluated previously. The aim of this study is to educate pediatricians, radiologists and surgeons to consider JS in the differential diagnosis of a child presenting with bilious vomiting. Materials and methods In this retrospective study from January 1999 to 2007, the records of all children with the complaint of intermittent A. Pandey Á V. Kumar Á A. N. Gangopadhyay (&) Á S. P. Sharma Á S. C. Gopal Á D. K. Gupta Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, UP, India e-mail: gangulybhu@rediffmail.com A. Pandey e-mail: dranand27@rediffmail.com S. C. U. Patne Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, UP, India 123 Pediatr Surg Int (2010) 26:213–217 DOI 10.1007/s00383-009-2527-3