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Case of Duodenal Obstruction

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This post is an answer to the Case – Neonate with Repeated Bile-Stained Vomiting

What radiological abnormalities are seen on the abdominal radiograph ?

  • ‘Double bubble’ sign due to the dilated stomach and the duodenum
  • No bowel gas in the rest of the abdomen

What are the radiological abnormalities on the upper GI contrast study ?

  • Bulbous/distended duodenal cap
  • Markedly distended stomach
  • No passage of contrast into the distal duodenum
First image: Abdominal X-ray of a neonate showing the ‘double bubble’ sign. One of the ‘bubbles’ is the distended stomach (black arrow) whereas the other ‘bubble’ is the bulbous duodenal cap (arrow). Note the rest of the abdomen is gasless.
Second image: Upper GI contrast study shows contrast opacification of the grossly distended stomach (black arrow) and the bulbousshaped duodenal cap (arrow). The rest of the duodenal loop and small bowel is not opacified, indicating complete obstruction and duodenal atresia. The diagnosis was confirmed at surgery.

Key Points

  • Double bubble sign is highly suggestive of duodenal obstruction.
  • Duodenal obstruction is a relatively common form of intestinal obstruction in the newborn.
  • Look for commonly associated syndromes and GI anomalies.

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