Snapshot A 45-year-old woman with polyhydramnios delivers a male infant with Down syndrome. Shortly after birth, the infant vomits greenish-yellow fluid. Imaging reveals two distinct pockets of air in the abdominal region. Introduction Congenital failure of the duodenal lumen to completely recanalize Results in stenosis of the duodenal passageway between the stomach and intestinal tract login to view 1 more bullet Epidemiology > 1:10,000 births ETIOLOGY Pathogenesis login to view 1 more bullet Associated with Down syndrome (20-30% of DS cases) and other birth defects login to view 1 more bullet Presentation Symptoms login to view 3 more bullets Physical exam login to view 2 more bullets imaging Radiograph login to view 3 more bullets Fetal ultrasound login to view 1 more bullet Differential Pyloric stenosis, tracheoesophageal fistula diagnosis Diagnosis based primarily on imaging Treatment Prevention login to view 1 more bullet Medical management login to view 4 more bullets Surgical intervention login to view 3 more bullets Complications Without treatment, condition is lethal Prognosis Full recovery is expected after surgical correction