Image Based Question-71107

A newborn presented with bilious vomitting.X ray shows the following features.What can be the most possible diagnosis?

A. Normal

B. Hypertrophic Pyloric Stenosis

C. Duodenal Atresia

D. Ileal Atresia

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Correct Answer » C Explanation

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

Annular pancreas

• 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

Ladd’s bands

• Fold of peritoneum attaching cecum to abdominal wall crosses over and obstructs duodenum.

Duodenal Atresia

• 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

Clinical Findings

• Bilious vomiting in first several hours of neonatal life with duodenal atresia

Imaging Findings

• 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

Treatment

• All congenital causes of duodenal obstruction require surgery

Prognosis

• If left untreated, it is fatal

• Prognosis will depend on the presence of associated cardiac, tracheo-esophageal, anal, renal, or skeletal abnormalities (VATER)