Vomiting is the process of expelling undigested food particles through the mouth or oral cavity. Most of the time nausea precedes vomiting. When vomiting occurs suddenly throwing out particles with force it is known as projectile vomiting. In this case there would not be any nausea feeling and excess of particles are propelled out from the mouth which spreads over short distance.
There will not be any gastric upset or discomfort during projectile vomiting. The pressure or force would be considerably high in case of projectile vomiting and for this reason it is termed as “projectile” meaning “propelled with intense pressure”. Bowel obstruction, increased intracranial pressure or overeating can be the cause of projectile vomiting. It is common in babies and newborns where the baby vomits almost after every feeding. This can lead to weight loss and dehydration also. For cases of bowel obstruction surgery is to be done for repairing.
Causes of Projectile Vomiting :
One of the common causes of projectile vomiting is bowel obstruction. The passage where the leftover stomach particles are emptied into the small intestine can get blocked fully or partially leading to bowel obstruction. In that case vomitus gets expelled with force causing projectile vomiting. Any unusual delay in the emptying of gastric particles and sudden increase in intracranial pressure may cause projectile vomiting. Intracranial pressure can build up due to brain hemorrhage, tumor or any severe infections. Vomiting after head injury should be treated immediately since it can be due to intracranial pressure.
Food poisoning and forceful feeding can also be the cause for projectile vomiting. When babies are overfed with force it can cause distension of esophagus area and stomach leading to projectile vomiting. Pyloric stenosis is the medical term used for gastric obstruction and often it is seen by birth. In infants presence of any foreign object in the upper gut area can also be the reason for projectile vomiting. This can happen when the baby puts any toy or object into his mouth which can get stuck into his gut. Ingestion of certain toxic substances by adults can affect the soft lining of the gut resulting in forceful vomiting.
- Patients who use emetics or those with eating disorders can indulge in purging resulting in projectile vomiting.
- In rare cases psychological causes like extreme fear or exposure to strong stimuli can cause projectile vomiting.
- In rare instance kidney problem can cause acidosis causing forceful vomiting.
Projectile Vomiting Symptoms :
Projectile vomiting differs from regular vomiting where nausea and dizziness may be present. Here the expulsion of particles from the mouth would be with force throwing the vomitus to short distance. Vomiting would follow shortly or immediately after feeding. In such cases babies would have persistent hunger and would cry for food after vomiting. Once the opening of pylorus becomes wide the vomiting would be forceful emitting milk to several feet. For some infants, it can cause stomach contractions before projectile vomiting and the babies’ stomach would produce wave like contractions. In severe cases it can cause dehydration and loss of weight.
Risk Factors :
Mothers of babies who have been smoking considerably during pregnancy are at increased risk of getting pyloric stenosis and projectile vomiting. Babies who are bottle fed are at risk of projectile vomiting.
Tests :
Based on the symptoms your doctor may examine the pyloric muscle by gently pressing on your stomach. He may order for ultrasound scan to check if pyloric stenosis is present and in some cases X-ray of the digestive system.
Treatment :
Projectile vomiting needs no medical treatment if the root cause of the problem is diagnosed. For people diagnosed with food poisoning proper antidote is given to expel the toxic food from the stomach. For infants with pyloric stenosis surgery is the only remedy. Pyloromyotomy is done by cutting the outer layer of pylorus muscle by clearing the food channel that is blocked. At present this surgery can be done via laparoscope by making a small incision on the baby’s navel.
It is minimally invasive procedure and the baby can be fed within few hours after surgery. He/she may be put on IV fluids to prevent dehydration and in some cases the baby may continue to vomit for few days which will get resolved later. The results are always excellent after the surgery and you can talk with your doctor to clear off any doubts. Your baby can get back home within couple of days after surgery.