A puzzling paradox: congenital bowel malrotation
\nmasquerading as duodenal atresia in a case of non-bilious
\nemesis

Intestinal malrotation is a congenital abnormal bowel position within the peritoneal cavity, usually involving small and large bowels. It is considered primarily a disease of infancy with infrequent occurrence beyond the first year of life. The twisting and malposition of the intestine can cut off the blood supply. If undiagnosed for a prolonged duration, it can be fatal. Diagnosing malrotation of the gastrointestinal (GI) tract in newborn babies in primary care settings can be challenging, where it needs a structured approach with supportive clinical findings and examinations. Although it can be a straightforward diagnosis, approximately 15% of upper GI (UGI) studies result in equivocal findings, leading to false-positive and false-negative interpretations.1 We report a case of a five-day-old infant presenting with nonbilious vomiting with radiographic imaging of a double bubble sign, which was subsequently found to have bowel malrotation.