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Neonate with mirror image of double bubble sign
  1. Niraj Kumar Dipak1,
  2. Suyodhan Reddy2,
  3. Kunal Kumar Jaiswal1,
  4. Abnish Kumar3
  1. 1 Department of Peds and Neonatology, Dr L H Hiranandani Hospital, Mumbai, Maharashtra, India
  2. 2 Department of Pediatric Surgery, B J Wadia Hospital for Children, Mumbai, Maharashtra, India
  3. 3 Department of Pediatrics and Neonatology, B J Wadia Hospital for Children, Mumbai, Maharashtra, India
  1. Correspondence to Dr Niraj Kumar Dipak, Department of Peds and Neonatology, Dr LH Hiranandani Hospital, Powai, Mumbai 400076, Maharashtra, India; neonatalsciences{at}

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A preterm 31-week baby girl weighing 1150 g was born to a 29-year-old primigravidae by spontaneous vaginal delivery, after antenatal polyhydramnios was identified at 30 weeks’ gestation. On admission in the neonatal intensive care unit, examination revealed a soft mass palpable in the epigastric region. X-ray of the chest and abdomen revealed the mirror image of a typical double bubble configuration with no gas in the remaining bowel, suggestive of duodenal atresia (‘reverse double bubble sign’). It was also conspicuous for situs inversus abdominalis with levocardia (figure 1).

Figure 1

Reverse double bubble sign.

Question 1

Features of prenatal diagnosis of intestinal obstruction include:

  1. Polyhydramnios. True or false?

  2. Small bowel lumen diameter >6–7 mm at any gestational age. True or false?

  3. Colonic lumen diameter >23 mm at any gestational age. True or false?

  4. Echogenic bowel. True or false?

Question 2

Duodenal atresia usually occurs due to:

  1. Congenital failure of recanalisation of the lumen at 8–10 weeks’ gestation. True or fa lse?

  2. Prenatal volvulus and torsion of vascular mesentery. True or false?

  3. Prenatal thromboembolic event. True or false? …

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  • Contributors NKD, SR, KKJ, AK were involved in the management of the patient, designing the Epilogue and drafting the manuscript. NKD was involved in the review of literature and will act as guarantor. The final manuscript was approved by all the authors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval Institutional Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.