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This month the Archives carries an article by Tan and Murugasu (see pp 100-102) on congenital pyloric atresia in siblings. The authors bring attention to an unusual malformation of the gastrointestinal tract which may occur in less than one in 1 million births. Since most atresias of the small intestine are not familial, the occurrence of this very rare malformation in two siblings from the same family is indeed rare. The cause of this form of atresia is not entirely clear, although the mechanism is believed to be different from that which produces atresias in the jejunum and ileum that usually occur late in gestation and produce shortening of the gastrointestinal tract. Congenital obstruction of the gastrointestinal tract by membranous diaphragms is most likely to affect the higher portions of the gastrointestinal tract, most commonly the duodenum. The "wind sock" obstruction of the duodenum produced by a distended pyloric diaphragm