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Journal of Perinatology (2011) 31, 223224r 2011 Nature America, Inc. All rights reserved. 0743-8346/11 http://www.nature.com/jp
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IMAGING CASE REPORT
Downs syndrome, duodenal atresia with paradoxical presence of distal bowel gas
TE Herman and MJ Siegel
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
Journal of Perinatology (2011) 31, 223224; doi:http://dx.doi.org/10.1038/jp.2010.151
Web End =10.1038/jp.2010.151
Case presentationA 3645-g male infant was born to a 34-year-old gravid 3, para 3 mother after a pregnancy complicated by gestational diabetes and abnormal fetal sonograms, which demonstrated an atrioventricular (AV) canal defect and polyhydramnios. Amniocentesis was performed, which showed trisomy 21. The baby was brought to the neonatal intensive care unit, where an initial plain radiograph of the abdomen (Figure 1) was performed. Because of persistent vomiting with oral feeds, an upper gastrointestinal (GI) contrast study was performed on the third day of life using water-soluble iodine-preparation contrast (Figure 2).
Denouement and discussionThe upper GI demonstrates duodenal atresia with so-called paradoxical presence of distal bowel gas. The gas is able to pass through the major and minor duodenal papillae, which straddle the area of atresia. The patient underwent duodenoduodenostomy for duodenal atresia on the fourth day of life and subsequent repair of AV canal was done as well.
Paradoxical presence of gas in the distal bowel with duodenal atresia appears to have been rst recognized in 1972.1 It must be differentiated from cases of partial duodenal obstruction with the presence of distal gas, such as duodenal stenosis, incomplete duodenal diaphragm, Ladds bands, annular pancreas or preduodenal portal vein....