Overview

Projectile vomiting refers to the sudden and forceful expulsion of stomach contents that occurs with significant intensity, often traveling several feet away from the body. It differs from ordinary vomiting due to its violent nature and distance. While occasional vomiting is common with many mild illnesses, projectile vomiting can be a sign of more serious underlying medical conditions, particularly in infants and young children. Prompt evaluation is important to determine the cause and prevent complications such as dehydration or nutritional deficiencies.

Causes

The causes of projectile vomiting vary by age group and underlying health conditions. Common causes include:

• Pyloric Stenosis (Infants): A common cause in newborns where the muscle between the stomach and small intestine thickens, blocking food passage and causing projectile vomiting.
• Gastrointestinal Obstruction: Blockages in the digestive tract, such as intestinal atresia or volvulus, can cause forceful vomiting.
• Gastroenteritis: Severe infections of the gastrointestinal tract can lead to forceful vomiting due to stomach irritation.
• Increased Intracranial Pressure: Conditions such as head trauma, brain tumors, or hydrocephalus can cause projectile vomiting without nausea.
• Migraines: Some individuals experience projectile vomiting during severe migraine attacks.
• Alcohol Poisoning or Drug Reactions: Excessive intake or adverse reactions can trigger intense vomiting episodes.
• Food Poisoning: Severe bacterial or viral foodborne illnesses can lead to rapid and forceful vomiting.
• Metabolic Disorders: Conditions like adrenal insufficiency or urea cycle disorders can occasionally present with projectile vomiting.

Symptoms

Projectile vomiting is often accompanied by other symptoms, which depend on the underlying cause:

• Frequent and Forceful Vomiting: Vomit may shoot out of the mouth forcefully, sometimes without preceding nausea.
• Dehydration Signs: Dry mouth, reduced urine output, sunken eyes, and lethargy.
• Weight Loss or Failure to Gain Weight: Particularly seen in infants with pyloric stenosis.
• Abdominal Distention or Discomfort: Swollen abdomen or signs of pain, especially in cases of obstruction.
• Headache or Visual Disturbances: In cases related to brain pressure or migraines.
• Fever or Diarrhea: Common in infections or gastroenteritis-related vomiting.
• Visible Peristalsis (Infants): Wavelike movements of the stomach seen in pyloric stenosis before vomiting occurs.

Diagnosis

Diagnosis involves a thorough medical history, physical examination, and relevant diagnostic tests to identify the cause of projectile vomiting:

• Medical History: Information on vomiting pattern, frequency, onset, associated symptoms, and recent illnesses.
• Physical Examination: Assessment of hydration status, abdominal tenderness, or neurological signs.
• Ultrasound (Infants): The preferred test for diagnosing pyloric stenosis, showing thickened pyloric muscle.
• Abdominal X-ray or CT Scan: Useful in identifying gastrointestinal obstructions or other structural abnormalities.
• Head Imaging (CT or MRI): Indicated if increased intracranial pressure or neurological symptoms are suspected.
• Blood Tests: Assess for electrolyte imbalances, dehydration, infection markers, or metabolic disorders.
• Stool Tests: To check for infectious causes in gastroenteritis or food poisoning cases.

Treatment

Treatment of projectile vomiting focuses on addressing the underlying cause and preventing dehydration and nutritional deficiencies:

Immediate Care

• Fluid Replacement: Oral rehydration solutions or intravenous fluids to correct dehydration.
• Electrolyte Management: Correction of imbalances caused by excessive vomiting.

Condition-Specific Treatment

• Surgery for Pyloric Stenosis: A minor surgical procedure called pyloromyotomy effectively cures the condition in infants.
• Treatment of Infections: Antibiotics for bacterial infections or supportive care for viral causes.
• Management of Obstruction: Surgical intervention or endoscopic procedures for gastrointestinal blockages.
• Neurological Causes: Addressing brain tumors, trauma, or hydrocephalus through appropriate neurosurgical or medical interventions.
• Anti-nausea Medications: Prescribed in specific cases like migraines or certain infections.

Prognosis

The prognosis for projectile vomiting largely depends on its underlying cause and how promptly it is treated:

• Excellent Recovery (Pyloric Stenosis): Surgical correction leads to full recovery in infants with minimal long-term issues.
• Infection-Related Vomiting: Usually resolves within a few days with proper hydration and supportive care.
• Obstructions: Good outcomes with timely surgical intervention.
• Neurological Conditions: Prognosis varies depending on the underlying neurological issue and its severity.

Overall, with prompt medical attention, most causes of projectile vomiting are treatable with good recovery rates, especially in infants and children. Early diagnosis and appropriate treatment are key to preventing complications and ensuring a favorable outcome.