A 5-day-old neonate presents with bilious vomiting. Upper gastrointestinal contrast study shows the duodenum and proximal jejunum spiralling downward and to the right in a 'corkscrew' configuration. What is the MOST likely diagnosis?
- A Duodenal atresia
- B Hypertrophic pyloric stenosis
- C Midgut volvulus ✓
- D Jejunal atresia
Correct answer: C. Midgut volvulus
Explanation
The corkscrew pattern of the duodenum and proximal jejunum on a contrast upper GI series is the classic finding of midgut volvulus complicating intestinal malrotation, caused by twisting of the bowel around the narrow mesenteric pedicle. Duodenal atresia produces a double bubble without distal gas and is diagnosed on plain film, not by a spiral contrast course. Pyloric stenosis causes gastric outlet obstruction with non-bilious vomiting. Jejunal atresia shows dilated proximal loops without a spiral configuration.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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