If true bilious vomiting is determined to be present the pediatric surgeon should be consulted immediately, since midgut volvulus and malrotation are imminently life threatening. The initial imaging examination is a plain film of the abdomen and pelvis followed by an UGI series. If both of these examinations are inconclusive a barium enema is performed to assist in the determination of bowel anatomy and position. Further imaging, if necessary, should be performed after consultation with the pediatric radiologist.