An 8-hour-old neonate has bilious vomiting and a 'double bubble' sign on plain abdominal X-ray. The most likely diagnosis and the associated condition to exclude urgently is:

• A Malrotation with volvulus; Down syndrome
• B Jejunal atresia; cystic fibrosis
• C Pyloric stenosis; hypochloraemic alkalosis
• D Duodenal atresia; Down syndrome (trisomy 21) ✓

Explanation

The double bubble sign (two gas-filled structures separated by the pylorus) on plain X-ray is pathognomonic of duodenal atresia (or severe stenosis). It occurs at or near the ampulla of Vater. Up to 30% of cases are associated with Down syndrome (trisomy 21), which must be excluded. Treatment is duodenoduodenostomy. Malrotation/volvulus also causes bilious vomiting but shows a gastric bubble and 'cutoff' on X-ray without the classic double bubble.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.