Clinics in diagnostic imaging (13). Congenital duodenal obstruction

A newborn Chinese baby boy presented with repeated bile-stained vomiting. Plain radiograph showed a "double-bubble" shadow. Upper gastrointestinal series demonstrated, in addition to a dilated stomach, rounded dilatation of the second part of duodenum with partial obstruction. At operation, a diaphragm was found at duodenotomy over the waist of the proximal duodenal constriction. Excision of the diaphragm and transverse closure of the duodenotomy produced relief of the obstruction. The role of imaging and the surgical approach to duodenal diaphragm are discussed.