Clinical Presentation

A neonate with irritability, poor feeding, and bilious vomiting.

Further Work-up

(A) An abdominal radiograph demonstrates a paucity of bowel gas in the central abdomen, but no clear evidence of obstruction. This is an abnormal but nonspecific pattern of bowel gas. (B–E) Four images from a barium upper gastrointestinal examination performed with an orogastric tube. (B) Image demonstrates what could be mistaken for a complete duodenal obstruction, although the degree of dilatation is insufficient to suggest a congenital atresia or high-grade stenosis. (C) Image demonstrates contrast material passing beyond this point. (D,E) Images demonstrate a classic “corkscrew” duodenum (arrows), secondary to midgut volvulus. Note that the duodenojejunal junction is positioned inferiorly and superimposed over the spine, indicating malrotation (arrows).

Differential Diagnosis

• Malrotation with midgut volvulus: