Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
The patient was a full term female, 1 day old, noted to have copious secretions in the delivery room where 50 cc of bile stained gastric secretions were aspirated. Upon further questioning it was learned that a prenatal US at 20 weeks had revealed fetal bowel distension with no evidence of polyhydramnios.
Clinical Physical Exam:
The abdomen was soft, without palpable masses.
Clinical Differential Diagnosis:
An abdominal film from the first day of life showed a double bubble sign.
Imaging Differential Diagnosis:
Duodenal atresia, duodenal stenosis.
The patient was explored on the first day of life via a right supraumbilical transverse incision. The duodenum was seen to taper between the second and third portions. A nasogastric tube could not be advanced past this area of tapering. There appeared to be a membrane obstructing the duodenum at this point. A duodenotomy was performed which confirmed the presence of a thick membrane completely obstructing the duodenum. Bile was seen above and below this membrane. The bile was coming from one papilla above the membrane and one below it. The dividing membrane was then incised.
Duodenal Atresia with air passing distally through pancreatic ducts
Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.
Case 4, Case 6, Case 14, Case 18, Case 23
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