School ager with Trisomy 21 and vomiting with feeding Pediatric Imaging Gastrointestinal February 13, 2019July 16, 2019 AXR (above) shows the tip of the nasogastric tube within a very dilated duodenal bulb. There is extensive distal bowel gas. Spot image from an upper GI exam (below) shows a fixed area of narrowing between the first and second portions of the duodenum through which contrast passed slowly. The diagnosis was duodenal stenosis. Related Published February 13, 2019July 16, 2019