This x-ray shows the typical double-bubble effect seen with complete duodenal obstruction. The smaller bubble represents the proximal, dilated duodenum (white arrow); the larger bubble represents the stomach (black arrow). This effect can be seen with duodenal atresia, duodenal web, annular pancreas, and preduodenal portal vein. Rarely, it can also be seen with complete duodenal obstruction resulting from Ladd bands in a patient with malrotation.