Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
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.
Clinical Differential Diagnosis:
Duodenal atresia and esophageal atresia
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.
Images 2 and 3
Imaging Differential Diagnosis:
Duodenal atresia and esophageal atresia.
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.
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.
The patient therefore underwent a cervical esophagostomy. Later, the patient had a definitive esophageal colonic interposition.
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