Correct answer to Q1 is: Incomplete obstruction of the 2^nd segment of duodenum

Correct answer to Q2 is: Small bowel follow through.

Additional Images:

Discussion:

In a small bowel follow through examination the baby drinks water soluble oral contrast and fluoroscopy images are obtained consequtively. This examination shows dilated stomach and proximal duodenum, but slight, delayed passage. There is no stenosis at the level of the pylorus. The proximal jejunal bowel loops are located in the correct anatomical position (upper left quadrant). The examination indicates a partial obstruction (a web) in the 2^nd part of the duodenum. The patient underwent surgery which confirmed the finding of a duodenal web.

Ultrasound is a non-invasive examination, which is readily available also in the acute setting. It is often a supplement to plain abdominal film in the acute pediatric setting. It is helpful to determine the level of obstruction and may indicate the cause.

Conclusion

Vomiting in neonates or small infants may indicate obstruction.

Conflicts of interest

“The authors declare no conflict of interest.”

References

1. Weerakkody, Y., Glick, Y. Duodenal web. Reference article, Radiopaedia.org. (accessed on 16 May 2022) https://doi.org/10.53347/rID-7630
2. Poddar U, Jain V, Yachha SK, Srivastava A. Congenital duodenal web: successful management with endoscopic dilatation. Endosc Int Open. 2016;4(3):E238-E241. doi:10.1055/s-0041-110955