case_images: PMC11369743_01
case_images: (a) An anterior-posterior projection film of an upper gastrointestinal series done under fluoroscopy for suspected bowel obstruction. The paperclips indicate the midline. There is absence of a normal descending C-loop of duodenum with scanty contrast into the small bowel. The small bowel loops appear to be centrally located. (b) A right anterior oblique projection film of the same patient demonstrates an elevated pylorus with the duodenum oriented postero-superiorly. (c) A right anterior oblique projection further shows that the duodenum appears to be oriented postero-superiorly with dilatation of the first segment. (d) Intra-operative photo of a 6-day-old neonate who underwent an exploratory laparotomy for intestinal obstruction. The forceps is indicating an intraperitoneal membrane encasing the duodenum creating the impression of a duodenal cocoon.
case_images: SAJR-28-2936-g001.jpg
case_images: PMC11369743_01_SAJR-28-2936-g001.jpg
case_images: F0001
case_images: However, there was scanty contrast passing through the pyloric sphincter into the small bowel, with the pylorus appearing elevated and the duodenum oriented postero-superiorly (Figure 1a-c). Thickened Ladd's bands were found as well as an accessory intraperitoneal membrane encasing the duodenum creating a cocoon-like structure, which was later diagnosed as CPE (Figure 1d).