Duodenal atresia

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[edit] Discussion of Duodenal atresia

  • Infants with duodenal atresia present with bilious vomiting early in the neonatal period.
  • The atretic segment is most often just beyond the ampulla of Vater at the junction of foregut and midgut.
  • If the atresia is proximal to the ampulla, the vomiting is nonbilious.

  • The prevalence of duodenal atresia is one in 10,000 newborns.
  • There is no sex-associated difference in prevalence.
  • Although more distal small-bowel atresia is believed to be secondary to an ischemic episode, duodenal atresia is thought to represent a failure of recanalization of the bowel lumen that is a solid tube early in fetal life.

  • Duodenal atresia is associated with many congenital syndromes, the foremost being Down syndrome. Approximately 30% of children with duodenal atresia have trisomy 21.
  • There is also an association with anomalies of the VACTERL (vertebral, anorectal, cardiac, tracheoesophageal, renal, and limb anomalies) spectrum.

  • By differentiating intrinsic obstructive causes such as duodenal atresia, stenosis, and web from potentially catastrophic midgut volvulus is important, particularly if surgical treatment will be delayed.
  • While an upper gastrointestinal series will resolve the dilemma, specific findings at clinical examination and with radiography are useful.
  • Intrinsic causes of obstruction result in a chronically distended duodenal bulb that is larger than the duodenal bulb in the midgut volvulus.
  • If the stomach is distended and the duodenum is nearly normal or only slightly distended, then the diagnosis of intestinal malrotation and midgut volvulus must be considered, and an upper gastrointestinal series is the study of choice.

  • Surgical treatment for duodenal obstruction includes a number of different techniques for the intrinsic causes, including duodenoduodenostomy and duodenojejunostomy

[edit] Imaging Findings for Duodenal atresia

  • For the neonate with the classic appearance of a double bubble, additional radiologic investigation is unnecessary, and the surgeon is alerted to plan for surgery, since all congenital causes of duodenal obstruction require surgery.
  • The double bubble sign is a finding observed on radiographs of newborns and infants.
  • The finding depicts two air-filled structures in the upper abdomen, with little or no air distally.
  • The proximal left-sided bubble is the air- and fluid-filled stomach. The proximal duodenum represents the second bubble to the right of the midline.
  • It is reproducible with a variety of other imaging modalities, including upper gastrointestinal studies and sonography.

[edit] Images

Patient #1: Mom had CT scan to rule out appendicitis. Duodenal atresia incidentally noted

[edit] See Also

[edit] External Links

[edit] References for Duodenal atresia