Congenital duodenal obstruction due to duodenal atresia along with annular pancreas, intestinal malrotation and preduodenal portal vein.

A newborn delivered by emergency lower segment caesarean section at 35 weeks of gestation suspected duodenal atresia antenatally with maternal ultrasonogram showing double bubble sign. After birth, the baby was stabilised and taken up for laparotomy and was found to have duodenal atresia along with intestinal malrotation, annular pancreas and preduodenal portal vein (PDPV). Ladd's procedure with Kimura's duodenoduodenostomy was performed. In a similar previously reported case study, a gastrojejunostomy was conducted;5 here, we were able to do a duodenoduodenostomy which is a better physiological anastomosis than a gastrojejunostomy since we achieved adequate duodenal mobilisation after the Ladd's procedure. Postoperatively, the patient recovered well, tolerated feeds, passed stools and gained adequate weight.