A newborn presents with sudden onset of green, bilious vomiting and bloody stools. What is the most likely diagnosis?

The clinical presentation of a newborn with sudden onset of green, bilious vomiting and bloody stools is suggestive of malrotation, particularly in the context of intestinal obstruction. In malrotation, the normal rotation and fixation of the intestines during fetal development are disrupted, leading to a potential volvulus, where the intestines twist around themselves. This can obstruct blood flow, resulting in compromised intestinal integrity and subsequent ischemia, which may manifest as bilious vomiting (green vomit indicates bile) and the presence of blood in the stool due to necrosis of the affected bowel segments.

This combination of symptoms is significant since bilious vomiting indicates that the obstruction is distal to the entry of bile into the gastrointestinal tract. The presence of bloody stools further emphasizes the severity of the condition, as it typically indicates ischemia or injury to the bowel tissue. Timely diagnosis and surgical intervention are crucial to prevent serious complications such as bowel necrosis.

In contrast, pyloric stenosis typically presents with non-bilious projectile vomiting and does not cause bloody stools. Intussusception can cause abdominal pain and intermittent vomiting, but is less common in newborns compared to older infants and usually does not present with bilious vomiting as a primary symptom. Appendicitis is rare