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Duodenal atresia; Radiograph of abdomen with double-bubble sign from duodenal atresia: Specialty: Pediatric gastroenterology, Pediatric surgery: Symptoms: Antenatal period: polyhydramnios Neonatal period: bilious or non-bilious vomiting within first 36 hours of life, abdominal distension, lack of stooling
Cases without distal gas are usually related to duodenal atresia, while high obstruction with distal gas need an upper gastrointestinal series because of the need to distinguish duodenal web, duodenal stenosis and annular pancreas from midgut volvulus, the latter being a surgical emergency. Confirmation is ultimately by surgical intervention. [6]
Frontal view of the abdomen with double bubble sign, patient was found to have duodenal atresia. In radiology, the double bubble sign is a feature of pediatric imaging seen on radiographs or prenatal ultrasound in which two air filled bubbles are seen in the abdomen, representing two discontiguous loops of bowel in a proximal, or 'high,' small bowel obstruction.
In cases of volvulus, plain radiography may demonstrate signs of duodenal obstruction with dilatation of the proximal duodenum and stomach but it is often non-specific. Ultrasonography may be useful in some cases of volvulus, depicting a "whirlpool sign" where the superior mesenteric artery and superior mesenteric vein have twisted.
Intestinal atresia occurs in around 1 in 3,000 births in the United States. [1] The most common form of intestinal atresia is duodenal atresia. It has a strong association with Down syndrome. [12] The second-most common type is ileal atresia. 95% of congenital jejunoileal obstructions are atresias; only 5% are stenoses. [2]
Other abnormalities include anal atresia, absence of the rectum and sigmoid colon, esophageal and duodenal atresia, and a single umbilical artery. Presence of a diaphragmatic hernia is also common in these fetuses/infants. Additionally, the alveolar sacs of the lungs fail to properly develop as a result of the reduced volume of amniotic fluid.
The digestive tract was also often abnormal; duodenal atresia, pyloric hyperplasia, malrotation and common mesentery were present in about half of the patients. When the brain was examined, more than half were found to have Dandy–Walker anomaly and/or agenesis of the corpus callosum. A few patients demonstrated cloudy cornea.
This clinically manifests as poor feeding and bilious vomiting in neonates. Screening can be performed with an upper GI series. The most severe complication of malrotation is midgut volvulus, in which the mesenteric base twists around the superior mesenteric artery, compromising intestinal perfusion, leading to bowel necrosis.