Double bubble (radiology)

[4] A fluoroscopic study known as an upper gastrointestinal series is often the next step in management in patients that are not critically ill, though if volvulus is suspected, emergent surgical intervention is mandated.

If clinical findings are equivocal, caution with non water-soluble contrast is needed, as the usage of barium can impede surgical revision and lead to increased post operative complications.

Non ionic water-soluble contrast should be used, as the hyperosmolar agents, if aspirated, can result in life-threatening pulmonary edema.

[5] Certain rare anatomic anomalies, such as congenital duodenal duplication[6] and pyloric atresia[7] can cause false positives for the sign on radiographs.

[8] Duodenal atresia, while typically without distal gas, has been reported with an absent double bubble, though this variant is quite rare.