What condition is indicated by sudden onset of green, bilious vomiting and blood per rectum in neonates?

The scenario described, which involves sudden onset of green, bilious vomiting and blood per rectum in neonates, is indicative of malrotation with volvulus. This condition occurs when the normal embryonic rotation of the intestine does not take place correctly, leading to abnormal positioning of the intestines. The volvulus refers to the twisting of the intestine, which can cause obstruction and potentially compromise blood supply to the affected segment of the bowel.

The presence of bilious vomiting is significant as it suggests that the obstruction is distal to the entry of bile into the gastrointestinal tract, indicating that the obstruction is severe. The blood per rectum can result from ischemic necrosis of the bowel due to the compromised blood supply from the twisted structures. This is a medical emergency that requires prompt surgical intervention to correct the malrotation and relieve the volvulus to prevent intestinal necrosis.

In contrast, celiac disease typically presents later in life and is not acute in nature. Pyloric stenosis generally results in projectile non-bilious vomiting due to gastric outlet obstruction, and duodenal atresia is often associated with bilious vomiting but typically presents with a "double bubble" sign on X-ray and does not often lead to bloody stools in neonates. Thus