We present a case of Jejuno-ileal atresia in a twin pregnancy with twin-to-twin transfusion syndrome.

Our imaging findings at 29 weeks gestation demonstrated distended bowel loops. A male neonate was born prematurely at 33 weeks and 4 days of gestation with an Apgar score of 10/10 and birthweight of 1600g. The physical examination of the newborn revealed ankyloglossia, testicular ectopia, moderate abdominal distention, failure to pass meconium with a normal anus. A nasogastric tube was inserted and bilious fluid obtained. A plain abdominal X-ray revealed a double bubble sign (Image 4). The newborn underwent surgical exploration on day 7 with the identification of a duodenal web resulting in extensive duodenal distension, as well as 16 other atretic intestinal segments at various locations in the jejunum and ileum. Surgical treatment involved resection of webs via a longitudinal incision and transverse suture. The neonate died 24 hours later from postoperative sepsis.