Incorrect. This is a blockage of the esophagus, as such there could be no bile in the vomit as the conduit of the esophagus is closed.

The symptoms of esophageal atresia are vomiting at first feeding as little to nothing can pass the esophagus, vomit typically non-forceful as abdominal contraction does not power the vomiting, no air in the stomach or intestines, no defecation.

Incorrect. A tracheoesophageal fistula is a connection between the trachea and esophagus, allowing air into the esophagus and food into the larynx. As respiration is normal, that indicates there is no food material entering the lungs.

The symptoms of tracheoesophageal fistula are excessive air in the stomach and intestines along with breathing difficulties or choking as material may be entering the lungs (particularly coughing/choking while feeding). Defecation occurs as food can pass to the stomach.

Incorrect. This is herniated intestines at the umbilicus covered by a membrane, a result of failure of the normal developmental GI tract herniation to retract. There is usually no intestinal obstruction so feeding and defecation are normal in the condition.

Incorrect. Pyloric stenosis is a narrowing or blockage of the pyloric sphincter. However, since the blockage is proximal to the biliary system the vomit would be non-bilious and thus not consistent with the patient symptoms.

The symptoms of pyloric stenosis include distended stomach with forceful vomiting, non-bilious as the blockage is proximal to the entry of the bile ducts, air bubble in the stomach but none in the duodenum or more distal intestines, no defecation.

Correct! This condition involves a blockage of the duodenum at any point (i.e. can occur from part 1 to part 4 of the duodenum). Since the vomit is bilious that indicates a block must be distal to the bile duct entry, thus duodenal parts 2-4.

The symptoms of duodenal atresia are distended stomach with forceful vomiting, non-bilious or bilious depending on whether the blockage is proximal or distal to the to the entry of the bile ducts, air bubble in the stomach and duodenum (double-bubble), but no air in more distal intestines, no defecation. Vomiting symptoms occur early (usually starting in the first day) as the stomach fills up quickly with feeding.

Incorrect. This is where the two developmental lobes of the pancreas fail to fuse and the individual has two structures (typically one larger lobe and one smaller lobe with separation between). This is typically asymptomatic.

Correct! This condition involves the pancreas tissue wrapped around the duodenum (i.e. 'annular'). Since the vomit is bilious that indicates a block must be distal to the bile duct entry, thus construction by the pancreas just distal to the bile duct.

Interestingly, despite the compression of pancreatic tissue around the duodenum, most of the time the bile duct is patent and only uncommonly blocked in this condition so bilious vomit is more common.

The symptoms of annular pancreas are similar do duodenal atresia with distended stomach, forceful vomiting, non-bilious or bilious depending on whether the blockage is proximal or distal to the to the entry of the bile ducts, air bubble in the stomach and duodenum (double-bubble), but no air in more distal intestines, no defecation.

Incorrect. This condition involves blockage or failure of the biliary ducts to form. As such, vomit cannot be bilious as the bile cannot reach the duodenum.

The symptoms of biliary atresia are normal feeding behaviors with the typical features of jaundice (e.g. yellowing of skin/eyes, pale stool, etc.).  

Correct! This is a severe malrotation of the bowel resulting in blockages and constrictions causing a twisting akin to a the coil of tissue when peeling an apple giving rise to the name.

The symptoms of apple peel atresia are distended stomach, forceful vomiting, bilious as the blockage is distal to the to the entry of the bile ducts, air bubble in the stomach and further along the intestines depending on where the blockage is distributed, but no air in more distal intestines, no defecation.

This is a surgical emergency as the malrotation can lead to ischemia and necrosis of the bowel.

Possible! An imperforate anus would block the ability of food to leave the GI tract causing back-up and forcible vomiting of bilious nature.

Typically vomiting occurs between 24-48 hours, as it takes some feeding time until the intestines become distended. Since the infant in this case started forcibly vomiting at 20 hours it is slightly early for imperforate anus. Thus this condition would be on a differential, although lower than other conditions

The symptoms of imperforate anus are similar to other blockages of the intestines such as duodenal atresia or apple peel atresia only occurring slightly delayed as the blockage is more distal.

Incorrect. This is herniated intestines at the umbilicus not-covered by a membrane (i.e. exposed to amniotic fluid). Usually a result of failure of the abdominal wall and herniation of the intestinal contents.

There is usually no intestinal obstruction so feeding and defecation can occur. However, there is significant inflammatory responses in the intestines due to contact with amniotic fluid that can delay bowel functional development. Acute and long-term constipation is common.