Duodenal Atresia

  • Etiology: congenital failure of recanalization
  • AXR: large air fluid levels in stomach and duodenal bulb with no distal bowel gas (double bubble sign)
  • 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.
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.