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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 20

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

Case 20

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

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
One day old full term female with bilious aspirates.

Clinical History:
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 Labs:

Clinical Differential Diagnosis:
Duodenal atresia.

Imaging Findings:
An abdominal film from the first day of life showed a double bubble sign.

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Imaging Differential Diagnosis:
Duodenal atresia, duodenal stenosis.

Operative Findings:
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.

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Pathological Findings:

Final Diagnosis:
Duodenal Atresia with air passing distally through pancreatic ducts

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
Case 4, Case 6, Case 14, Case 18, Case 23


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