Neonatal Bowel Obstruction - High vs Low

In neonates presenting with bilious vomiting, a single abdominal radiograph can distinguish between high and low bowel obstruction.

• High obstructions (like duodenal atresia) display one to a few dilated air-filled loops,

• while low obstructions (like Hirschsprung disease or meconium ileus) present with multiple dilated bowel loops.

This distinction dictates the next step: high obstructions usually require surgery, whereas low obstructions need a contrast enema for diagnosis.