Imaging recommendation · Abdomen · Pelvis

Neonatal bilious vomiting, suspected duodenal atresia

Q: What's the alternative imaging for neonatal bilious vomiting, suspected duodenal atresia when upper gi to exclude malrotation?

XR — Upper GI series (oral contrast).

Recommended: Abdominal X-ray (double bubble sign) is the preferred imaging study for neonatal bilious vomiting, suspected duodenal atresia. Distal duodenum atresia (most common).

Recommended study

Abdominal X-ray (double bubble sign)

XR No contrast Preferred Abdomen · Pelvis Emergency Reviewed 2026-05

Distal duodenum atresia (most common). Often diagnosed prenatally; associated with Down syndrome.

If the default doesn't apply

Upper GI to exclude malrotation

XR Upper GI series Oral contrast

Watch-outs

Malrotation can mimic

Malrotation with midgut volvulus is the surgical emergency — exclude with UGI.

Pearls

Down syndrome in ~30%.
Prenatal US: dilated stomach + duodenum + polyhydramnios.
Surgical repair (duodenoduodenostomy) shortly after birth.