Duodenal obstruction in neonates and infants should be considered a surgical emergency until the diagnosis of malrotation with potential midgut volvulus are often ruled out. In a neonate with a presentation of duodenal obstruction, an upper gastrointestinal (GI) contrast study must be obtained urgently to determine the presence of a GI rotational abnormality. Diagnosis of duodenal atresia can be suspected prenatally if there is polyhydramnios, dilated bowel, ascites, or a combination. Postnatally, infants with duodenal atresia present with polyhydramnios, feeding difficulties, and emesis which will be bilious. The diagnosis is suspected by symptoms and classic double-bubble x-ray findings-one bubble is in the stomach and the other is in the proximal duodenum; little to no air is in the distal gut. Once the disorder is suspected, infants should receive nothing orally , and a nasogastric tube should be placed to decompress the stomach. Surgical intervention is indicated in by failure of the medical treatment, preference of the patient for surgical correction instead of following strict medical treatment and therefore the presence of associated disease such as peptic ulcer and pancreatitis.