Persistent Vomiting of Bile In a Premature Infant

History  A 12-hour-old premature infant was first seen with persistent bilious vomiting. He had not yet been fed and had passed meconium ten hours after birth. On physical examination, he was found to have peculiar facies and upper abdominal distention.Figures 1 and 2 were obtained as part of the diagnostic evaluation.

Diagnosis  Duodenal atresia.

Comment  Figures 1 and 2 show two air-filled upper abdominal structures representing the very dilated stomach and duodenal bulb. The remainder of the alimentary tract was gasless. This combination of findings suggested congenital duodenal obstruction.Further inspection of Fig 1 disclosed an unusual configuration of the pelvis. The superior margins of the acetabula were flat and the ilia were flared. These findings suggested Down syndrome (trisomy 21), a condition commonly associated with duodenal atresia.Duodenal obstruction accounts for about 25% of all cases of alimentary tract obstruction in newborns. It occurs in about 1 in