Duodenal obstruction in the setting of situs inversus abdominis is an uncommon clinical finding. We report 2 neonates who presented with bile-stained vomiting and abdominal distension. Diagnostic workup, including radiography and ultrasonography, confirmed the diagnosis of situs inversus abdominis with duodenal obstruction due to annular pancreas in the first case and due to intestinal malrotation in the second. A Ladd’s procedure was successfully performed to relieve the obstruction. Both patients recovered well, initiating full enteral feeds and were subsequently discharged. These cases underscore the diagnostic challenges posed by this rare association and highlight that a standardized surgical approach, adapted to the mirror-image anatomy, can lead to a successful outcome. Early recognition and tailored intervention are crucial in the management of these complex patients.
Shreef et al. (2026) studied this question.