Summary The clinical features of an uncommon form of small bowel or duodenal atresia have been described and the descriptive term “apple peel” suggested for this anomaly. Treatment has been discussed and a combination of resection, Bishop-Koop anastomosis, with a gastrostomy, and feeding tube led into the distal bowel recommended. The problem of pathogenesis of a lesion combining the features of an error of growth with an apparent vascular accident has been raised.