Abstract Background: Bile stained vomiting in neonates is fre-quently encountered clinical symptom in pediatric practice. It is very important to examine them and exclude or confirm surgical condition. Aim of Study: This work is advocated to illustrate the spectrum of radiological findings in neonates with bile stained vomiting and correlate them with surgical data. Patients and Methods: All included neonates presented with bile stained vomiting were referred to Diagnostic Radi-ology Department at Sohag University Hospitals. Abdominal X-ray, abdominal ultrasound, Doppler and contrast imaging were done to identify the surgical causes of bilious vomiting with clinical and surgical correlation. The patients were treated surgically in Pediatric Surgery Unit at Sohag University Hospitals. Patients with bilious vomiting caused by non-surgical causes were excluded. Results: Our study included 31 bile stained vomiting neonates with age range from one day to 30 days and with male sex predominance (17 boys and 14 girls). Four patients were found to have necrotizing enterocolitis, 5 cases with mid-gut volvulus, 3 cases were found to have distal duodenal atresia, one case with duodenal stenosis, 5 cases with jejunal atresia, 4 cases with ileal atresia, 2 cases with congenital bands, 2 cases with complicated congenital inguinal hernias, 2 cases with meconium plug, 1 case with neonatal intussus-ception, 1 case with iatrogenic clamping of umbilical hernia and 1 case with anal stenosis. Imaging techniques were diagnostic in most of the cases and correlate with surgical findings. Conclusion: Bile stained vomiting in the newborn usually indicative of surgical conditions and needs surgical consulta-tion. Imaging studies are of utmost important to investigate and diagnose these cases before surgery.