A newborn presented with bilious vomitting.X ray shows the following features.What can be the most possible diagnosis?
B. Hypertrophic Pyloric Stenosis
C. Duodenal Atresia
D. Ileal Atresia
Ans:C. Duodenal Atresia.
Image shows:Supine radiograph of the abdomen demonstrates a dilated stomach and an accompanying dilated proximal duodenum . There is no gas in the bowel distal to the dilated duodenum. This is called the “double bubble” sign and usually indicates the presence of duodenal atresia.
Double Bubble Sign
- Represents duodenal obstruction from one of several causes:
- Duodenal atresia
- Complete obstruction by an atretic lumen
- Duodenal web or stenosis
- Partial obstruction by a diaphragm
- Milder form of atresia
- Pancreas surrounds the 2nd portion of duodenum
- Since it is frequently associated with duodenal atresia, it has the same conventional radiographic findings
- Malrotation of the bowel with a midgut volvulus, or With midgut volvulus, the majority of the small bowel is involved and strangulates if not de-volvulated
- Fold of peritoneum attaching cecum to abdominal wall crosses over and obstructs duodenum.
- 1:6,000 newborns
- Atresia is usually just distal to ampulla of Vater
- Most common cause of congenital duodenal obstruction
- Failure of canalization of duodenum
- About 30% of children with duodenal atresia will have Down Syndrome
- Bilious vomiting in first several hours of neonatal life with duodenal atresia
- Larger, proximal “bubble” is air in a dilated stomach
- More distal, smaller “bubble” is air in a dilated proximal duodenum
- There is usually little or no air in the bowel distal to the obstruction
- No oral or rectal contrast is usually needed to diagnose duodenal atresia
- Double bubble may also be seen on prenatal ultrasounds
- All congenital causes of duodenal obstruction require surgery
- If left untreated, it is fatal
- Prognosis will depend on the presence of associated cardiac, tracheo-esophageal, anal, renal, or skeletal abnormalities (VATER)