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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 18

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 18

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Newborn full term male with a double bubble sign on prenatal ultrasound and failure to pass a nasogastric tube at birth.

Clinical History:
This male was noted at 16 weeks on prenatal US to have polyhydramnios and a double bubble sign. A follow-up ultrasound at 24 weeks confirmed this finding. At birth at full term the patient had a massively distended abdomen and a nasogastric tube could not be passed to decompress the stomach.

Clinical Physical Exam:
The patient had a massively distended abdomen.

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Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Duodenal atresia and esophageal atresia

Imaging Findings:
Abdominal films obtained soon after birth showed a gasless distended abdomen. An abdominal ultrasound from the first day of life showed a double bubble sign of a distended stomach and a distended duodenum.

icon gificon gifImages 2 and 3

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Imaging Differential Diagnosis:
Duodenal atresia and esophageal atresia.

Operative Findings:
The patient was surgically explored on the second day of life. Duodenal atresia was encountered. The patient had a duodeno-duodenostomy and G-tube placement performed.

icon gifImage 5

Pathological Findings:
None

Final Diagnosis:
Esophageal Atresia and Duodenal Atresia

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course after the duodeno-duodenostomy and G-tube placement.

Contrast studies of the esophagus determined that it was impossible to perform a primary esophageal repair.

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The patient therefore underwent a cervical esophagostomy. Later, the patient had a definitive esophageal colonic interposition.

Similar Cases:
Case 20

References:

Title Page


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