IMAGE OF THE WEEK

WEEK 14

DUODENAL ATRESIA

Dudonenal atresia occurs in 1 in 2500-5000 live births, and therefore is an infrequent pathology in Brunei (Population 407,000 - crude birth rate of 19.8 per 1,000).

The incidence is higher in patients with Down Syndrome, with up to 40% of all patients being from this subgroup. Its frequency is equal in both males and females.

A duodenoduodenostomy is the most commonly performed surgical procedure to overcome the atretic segment.

RADIOLOGY

The classical appearances on plain abdominal radiograph are of the ‘Double Bubble’ sign.  The larger bubble (in this case the tip of the NG tube is within) is the distended gas filled stomach and the smaller bubble is gas within the blind ending (atretic) duodenum.

Ideally the diagnosis is made on antenatal ultrasound, when the fluid filled stomach and duodenum are seen as a ‘double bubble’. It is associated with polyhydramnios.

See:  http://www.sciencephoto.com/images/download_wm_image.html/C0036189-Foetus_with_duodenal_atresia,_ultrasound-SPL.jpg?id=670036189

A fluoroscopic study will also outline the duodenal atresia, but is not usually necessary.

The condition is associated with renal anomalies so ultrasound also performed during the post natal period.

Images prepared by Dr Ian Bickle, Consultant Radiologist, RIPAS Hospital, Brunei Darussalam.

All images are copyrighted and property of RIPAS Hospital.