Duodenal Atresia

Etiology: Congenital failure of recanalization
Imaging AXR: Large air fluid levels in stomach and duodenal bulb with no distal bowel gas (double bubble sign)
DDX: Duodenal stenosis, duodenal web
Complications: Multiple gastrointestinal atresias can exist in the same patient so it is important for surgeon to run the entire bowel during repair
Treatment: Surgical
Clinical: Can be associated with esophageal atresia, annular pancreas, Trisomy 21, congenital heart disease

Radiology Cases of Duodenal Atresia

AXR of duodenal atresia — Supine (left) and upright (right) AXR shows large air fluid levels in the duodenal bulb (to the right of the spine) and in the stomach (to the left of the spine). There is no distal bowel gas.

CXR | AXR shows a nasogastric tube in the proximal esophagus and a massively distended abdomen. Transverse US image of the upper abdomen (below) shows a dilated duodenal bulb (left) and a dilated stomach (right), a double-bubble sign.

UGI of duodenal atresia — AP (above) and lateral (below) images from an UGI exam show a dilated stomach and first part of the duodenum. On a delayed image obtained 15 minutes later, no contrast was seen to have passed out of the duodenum into the remainder of the bowel.

Radiology Cases of Duodenal Atresia With Air Passing Distally Into the Small bBowel Through the Biliary Tree and Pancreatic Ducts.

AXR of duodenal atresia — AXR AP shows a double bubble sign with a dilated stomach to the left of the spine and duodenum to the right of the spine with a small amount of distal bowel gas.

Clinical Cases of Duodenal Atresia

Clinical image of duodenal atesia — Clinical image shows a massively distended abdomen.

Surgery Cases of Duodenal Atresia

Surgical image of duodenal atresia — Surgical image shows a massive fluid filled stomach (on the left) and duodenal bulb (on the right) which was found to contain over 400 cc of fluid.

Surgical image of duodenal atresia — In the operating room the duodenum was seen to taper between its second and third portions. A nasogastric tube could not be advanced past this area of tapering. There appeared to be a membrane obstructing the duodenum at this point. A duodenotomy was performed which confirmed the presence of a thick membrane completely obstructing the duodenum. Bile was seen above and below this membrane. The bile was coming from one papilla above the membrane and one papilla below it. Surgical image shows the superior retractor distracting the proximal duodenum and the inferior retractor distracting the distal duodenum. The obstructing membrane is seen between the retractors. The obstructing membrane was then incised.

Surgical image of duodenal atresia — Surgical image shows the dilated first part of the duodenum in the center of the image and the normal caliber second part of the duodenum being held between the forceps. There was a 5 cm gap between the first and second parts of the duodenum.