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Upper GI for high obstruction in newborn
Patient preparation: none
Contrast used: low osmolar water soluble or iso osmolar water soluble or barium – never use high osmolar water soluble because if aspirated it can cause severe pulmonary edema, if the clinical picture is highly suggestive for duodenal atresia you may simply inject air
Technique: — Insert 8 French feeding tube into the stomach and pass tube transpyloric into the duodenal bulb, with patient in supine position inject 5-10 cc of contrast through the feeding tube to opacify duodenal C-loop and document the position of the duodenal-jejunal junction, flush the tube with sterile saline if it is being left in place, follow contrast through small bowel to level of obstruction — If feeding tube tip cannot be passed out of stomach then aspirate stomach contents, place patient left side down, inject 5-10 cc of contrast through the feeding tube, turn to right side down to facilitate gastric emptying, when contrast is seen to enter 3rd/4th part of duodenum, turn the patient supine and document the position of the duodenal-jejunal junction, flush the tube with sterile saline if it is being left in place, follow contrast through small bowel to level of obstruction
Images to obtain: AP image of duodenal-jejunal junction, AP image of level of obstruction, consider delayed images to differentiate stenosis from atresia