Content area
Full Text
Pediatr Radiol (2014) 44:10311034 DOI 10.1007/s00247-014-2896-1
CASE REPORT
Duodenal atresia: not always a double bubble
Jonathan M. Latzman & Terry L. Levin &
Suhas M. Nafday
Received: 9 October 2013 /Revised: 29 December 2013 /Accepted: 22 January 2014 /Published online: 21 February 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract A newborn infant with a prenatal diagnosis of duodenal atresia and abdominal radiographs demonstrating air in distal bowel is presented. An upper gastrointestinal series revealed complete duodenal obstruction and duodenal atresia was confirmed at surgery. The significance of distal bowel gas and the embryological development of this unusual entity is discussed.
Keywords Duodenum . Radiography . Upper Gastrointestinal series . Duodenal atresia . Anomalous duct . Infant
Introduction
Duodenal atresia, a failure of recanalization of the duodenum during embryonic life, occurs with a frequency of 1 in 7,500 births [1]. Antenatal sonographic findings include polyhydramnios as well as dilatation of the stomach and proximal duodenum [2]. An infant with duodenal atresia typically presents in the first few hours of life with bilious emesis. (The emesis may be nonbilious if the atresia occurs above the ampulla.) Classically, the abdominal radiograph demonstrates the double bubble, representing the air-filled stomach and duodenum. Distal bowel gas is typically absent
[3]. Radiographs in infants with duodenal atresia rarely demonstrate air in distal bowel due to the anomalous development of the biliary tree that serves as a conduit between the obstructed proximal duodenum and the non-obstructed distal duodenum. In these infants the diagnosis of bowel atresia may be missed. We present a case and discuss the embryological development of this unusual entity.
Case report
A 32 weeks preterm male infant with a prenatal diagnosis of duodenal atresia and polyhydramnios was admitted to the neonatal intensive care unit following a cesarean section for complete breech presentation. The infant was apneic and cyanotic at birth and initially required positive pressure ventilation. An abdominal radiograph was obtained and demonstrated an air-filled, distended stomach and proximal duodenum with air distal to the duodenum (Fig. 1).
An upper gastrointestinal series (UGI) revealed complete obstruction to the flow of contrast at the second portion of the duodenum (Fig. 1). A US demonstrated a fluid-filled proximal duodenum and intermittent...