Ans. b. Babygram (Ref: Nelson 19/e p1278; Sabiston 19/e p1841-1842; Schwartz 9/e p1427-1428; Bailey 26/e 120, 25/e p85; Shackelford 7/e p811-813)A neonate presented on day one of life with bilious vomiting. First investigation to be done is Babygram (full body radiograph of the baby) to rule out duodenal atresia. Babygram is a full body radiograph of the baby, which shows the double bubble sign in duodenal atresia.The hallmark of duodenal obstruction is bilious vomiting without abdominal distention, which is usually noted on the 1st day of life. Peristaltic waves may be visualized early in the disease process. The diagnosis is suggested by the presence of a 'double-bubble sign' on plain abdominal radiographs. The appearance is caused by a distended and gas-filled stomach and proximal duodenum. Contrast studies are usually not necessary and may he associated with aspiration if attempted. Contrast studies may occasionally be needed to exclude malrotation and volvulus because intestinal infarction may occur within 6-12 hr if the volvulus is not relieved.'- Nelson 19/e p1278Duodenal AtresiaOccurs as a result of failure of vacuolization of the duodenum from its solid cord stageAnatomic variants of Duodenal AtresiaDuodenal stenosisMucosal web with intact muscular wall (windsock deformity)Two ends separated by a fibrous cordComplete separation with a gap within the duodenum.Associated Anomalies:Prematurity, Down syndrome, polyhydramniosQMalrotation, annular pancreas, biliary atresiaQCardiac, renal, esophageal, and anorectal anomaliesClinical Features:In most cases, the duodenal obstruction is distal to the ampulla of Vater, and infants present with bilious emesis in the neonatal periodQ.DiagnosisX-ray abdomen: Double-bubble sign (air-filled stomach and duodenal bulbQ).Diagnosis is confirmed, if there is no distal airQ.If distal air is present, an upper GI contrast study is performed rapidly, not only to confirm the diagnosis of duodenal atresia but also to exclude midgut volvulusQ.Treatment:Diamond-shaped duodenoduodenostomy is the treatment of choiceQSingle bubble signCongenital Hypertrophic Pyloric StenosisQDouble bubble signDuodenal atresiaQ, Annular pancreasTriple bubble signJejunal atresiaQ