Gastric outlet obstruction is also a common cause of projectile vomiting in adults but often for different reasons from that of infants. Ingestion of caustic substances may also be a cause. This is more common among toddlers than other age groups. Abdominal pain of sudden onset which aggravates upon eating or attempting to defecate and is tender to touch should raise the question about a foreign object. In toddlers and older children, an ingested foreign object may cause an obstruction within the upper gut. Intussusception, Hirschsprung’s disease and malrotation need to be considered as well. However, if the obstruction lies distal to the pylorus, as in duodenal atresia, the vomitus may contain bile ( bile vomit). It typically presents with forceful vomit that does not contain bile. This is often congenital and is usually seen within the first 3 months of birth. With newborn babies and infants, gastric outlet obstruction is often due to pyloric stenosis. In infants and children, stomach or bowel obstruction is one of the more common causes of projectile vomiting. Projectile Vomiting in Infants and Children Overeating, whether voluntary or forced, if sudden can cause significant distension of the esophagus, stomach and/or duodenum and impair gut motility. Raised intracranial pressure should always be investigated in vomiting following head injury. Hydrocephalus, intracranial bleeding (hemorrhage), tumor or infections like meningitis or encephalitis need to be considered as possible causes. Raised intracranial pressure may occur due to a number of reasons. Gastric outlet obstruction is discussed below in terms of more likely causes in infants or children and adults. Raised intracranial pressure, especially if it is of sudden onset.Other causes of delayed gastric emptying.The following causes need to be taken into account in babies, children and adults : However, any very strong stimulus that triggers the chemoreceptor trigger zone (CTZ) or vomit centers in the medulla could possibly result in projectile vomiting. This is where the passage of the stomach contents into the small intestine is either partially or completely obstructed. Projectile vomiting is often associated with gastric outlet obstruction. Depending on the rate and intensity of the contraction, vomiting can be fairly forceful. Overall, projectile vomiting is quite violent.Īs explained under the process of vomiting, the contractions that propel the upper gut contents out as vomitus starts from as low as the middle of the small intestine. For it to be termed as projectile, the pressure has to be significantly high within the gut and the vomitus has to be propelled a distance away from the body ( sometime even several feet). However, the term ‘ projectile vomiting‘ is often used quite indiscriminately to refer to any type of severe vomiting. Nausea usually does not precede projectile vomiting and it can occur suddenly without any indication of discomfort or gastrointestinal upset. It is often sudden with excessive vomitus passed out in each attack. Projectile vomiting is vomit that exits the mouth with such force in that it is propelled over a short but significant distance.
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