Vomiting is a common reflex that expels stomach contents. Projectile vomiting is a distinct and forceful type of expulsion. It involves the sudden and vigorous ejection of stomach contents, often propelling them a considerable distance. This form of vomiting can signal various underlying conditions, differing significantly from typical episodes of emesis.
Understanding Projectile Vomit
Projectile vomiting is characterized by the extreme force with which stomach contents are expelled. Unlike regular vomiting, which may involve retching and nausea beforehand, projectile vomiting frequently occurs suddenly, without warning or preceding nausea. The abdominal and diaphragmatic muscles contract powerfully, creating intense pressure within the stomach that propels the vomit outward, often several feet away. It often comes in shorter, more violent bursts compared to other types of vomiting.
Underlying Causes
Projectile vomiting can stem from various medical conditions and physiological responses, with causes differing across age groups. A notable cause in infants, typically between 3 weeks and 5 months of age, is pyloric stenosis. This condition involves a thickening and narrowing of the pylorus, the muscular valve connecting the stomach to the small intestine. The thickened muscle obstructs food passage, causing the stomach to contract forcefully and result in projectile vomiting.
Increased intracranial pressure (ICP), pressure within the skull, can also trigger projectile vomiting. Conditions like brain tumors, hydrocephalus, or head trauma can elevate ICP, stimulating the brain’s vomiting center. This type of vomiting may occur suddenly, sometimes upon waking from sleep. Gastrointestinal obstructions, beyond pyloric stenosis, can also lead to projectile vomiting in children and adults. These blockages, caused by conditions like intestinal twisting, adhesions, hernias, or tumors, prevent normal food flow, leading to pressure buildup and forceful expulsion.
Severe infections, particularly those affecting the gastrointestinal tract like viral gastroenteritis or norovirus, are common causes of vomiting in adults and children, and can sometimes present as projectile vomiting. Food poisoning, resulting from consuming food contaminated with bacteria or toxins, is another frequent cause, as the body attempts to rapidly expel the harmful substances. Furthermore, some individuals experience projectile vomiting during severe migraines, certain neurological conditions, or even from overeating, as the stomach tries to rid itself of excess contents.
When to Seek Medical Attention
While many instances of vomiting resolve on their own, certain accompanying symptoms with projectile vomiting signal a need for prompt medical evaluation. Dehydration is a significant concern, particularly in infants and young children, due to rapid fluid loss. Signs of dehydration include:
Reduced urination
Dry mouth and lips
Lack of tears when crying
Sunken eyes
Unusual drowsiness or irritability
In infants, a sunken soft spot (fontanelle) on the head is also a sign of dehydration.
Medical attention is also advised if projectile vomiting is accompanied by a high fever, severe abdominal pain, or a stiff neck. The presence of blood in the vomit, which might appear red or like coffee grounds, or green vomit, warrants immediate medical assessment. Green vomit can indicate bile, suggesting a bowel obstruction. Changes in mental status, such as confusion or lethargy, or if vomiting persists for an extended period (more than 24 hours for children and infants, or more than two days for adults), also indicate the need for professional medical advice.