Duodenal Obstruction Causes and Diagnostic Considerations

Intrinsic Causes

The American College of Radiology recommends recognizing duodenal atresia as the most common intrinsic cause of congenital duodenal obstruction, accounting for the majority of cases presenting with the classic "double bubble" sign on radiography 1
Duodenal web is a rare intrinsic cause that creates a membranous obstruction within the duodenal lumen, according to the American College of Radiology 1
Duplication cysts can cause obstructing lesions within the duodenal wall, as noted by the American College of Radiology 1

Malrotation with midgut volvulus is a surgical emergency that must be excluded urgently in any neonate with bilious vomiting, with 20% of infants with bilious vomiting in the first 72 hours having midgut volvulus, according to the American College of Radiology 1
Internal hernia can cause duodenal obstruction, particularly in post-bariatric surgery patients, as reported by the World Journal of Emergency Surgery 2
Carcinomatosis peritoneal can cause extrinsic compression of the duodenum, according to Praxis Medical Insights 3

Bilious vomiting within the first 2 days of life with the "double bubble" sign and no distal gas indicates duodenal atresia in 91% of cases, but malrotation with volvulus must be excluded as it requires emergency surgery, according to the American College of Radiology 1
Upper GI series is the gold standard for diagnosing malrotation/midgut volvulus with 96% sensitivity, as noted by Praxis Medical Insights 4
Never assume a double bubble sign is always benign duodenal atresia—malrotation with volvulus can present identically and requires immediate surgical intervention, according to the American College of Radiology 1
In young females with duodenal obstruction, consider ovarian masses, endometriosis, or pelvic inflammatory disease as potential causes, as suggested by Praxis Medical Insights 5