School ager with Trisomy 21 and vomiting with feeding

AXR and UGI of duodenal stenosis
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.