Primary Care Liaison

Bilious vomiting - pre-referral

  • This is an urgent surgical condition.

    Assessment and when to refer

    History is important

    • BILE stained vomit is GREEN (not yellow).
    • Assume mechanical obstruction until proven otherwise.
    • Especially dangerous in first year of life - one green vomit in a well baby is a classical presentation of small bowel volvolus.
    • URGENT referral to the Emergency Department in all cases - NEVER WAIT FOR THE 2ND GREEN VOMIT.


    References and more reading

    • Urgent paediatric surgical conditions - management guidelines by  Tom Clarnette MBBS, MD, FRACS (Paeds). Consultant Paediatric Surgeon, RCH, Melbourne, Australia.
    • Paediatric Handbook (2009). Gastrointestinal Conditions, Chapter 24 (pp369389) Mark Oliver and Lionel Lubitz. Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

    Guideline developed by RCH Gastroenterology. First published Dec 2007. Reviewed August 2009. Please read  Copyright and Disclaimer

    Thanks to Consultant Paediatric Surgeon Tom Clarnette for permission to adapt existing guidelines. Many thanks to the GPs involved in the review.