Differential diagnosis of high bowel obstruction in newborn

Approach to the differential diagnosis of high obstruction in the newborn:

  • Failure to pass a nasogastric tube is due to esophageal atresia
  • A double bubble sign on an AXR is nearly always due to duodenal atresia
  • Other causes of duodenal obstruction include duodenal web, duodenal stenosis, annular pancreas and malrotation with midgut volvulus
  • Several dilated loops of jejunum – a triple bubble sign – without distal gas should be due to jejunal atresia, if there is distal gas associated with dilated proximal jejunum consider jejunal stenosis
  • Any neonate with bilious vomiting needs an immediate upper GI to rule out malrotation with midgut volvulus