A 1-day-old neonate is noted to have bilious vomiting, a double-bubble sign on abdominal X-ray, and a distended upper abdomen. There is no distal gas. The most likely diagnosis is:

• A Malrotation with volvulus
• B Pyloric stenosis
• C Jejunal atresia
• D Duodenal atresia ✓

Explanation

A double-bubble sign on plain radiograph (air in the stomach and proximal duodenum with no distal gas) is pathognomonic of duodenal atresia. It occurs due to failure of recanalisation of the duodenal lumen (occurs at 8–10 weeks gestation from the solid cord stage). Duodenal atresia is associated with Down syndrome (30%), malrotation, and cardiac anomalies. Treatment is duodenoduodenostomy. Malrotation/volvulus shows variable gas pattern and is a surgical emergency.

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

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Written and medically reviewed by the StethoPrep medical team.