Differential diagnosis of high bowel obstruction in newborn

• Esophageal atresia
• Gastric atresia (antral / pyloric)
• Duodenal atresia
• Duodenal web
• Duodenal stenosis
• Annular pancreas
• Malrotation with midgut volvulus
• Jejunal atresia
• Jejunal stenosis

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