A 6 month old boy is brought into the emergency department. He has been crying constantly since early this morning and has had an episode of green vomit. He has no past medical history, is fully immunised and meeting all milestones. The only history of relevance is that there have been episodes of abdominal pain and vomiting over the last month.
On examination, the child looks unwell from the end of the bed. He is quieter now, and minimally interactive, however, when you examine the abdomen, which his mother says looks distended, there is pain. You call the surgeons for review and whilst waiting get IV access and perform an abdominal x-ray.
What are you concerned about in this child? What does the x-ray show? What is the likely diagnosis?
The keys to the puzzle here are the recent ‘grumbling’ abdominal symptoms, the inconsolable crying, the bilious vomiting ( remember bilious is BAD), the end of the bed impression of a sick child who is now quiet and the distended abdomen, with pain on palpation.
The Xray shows a “Double Bubble Sign”.