Pediatric Duodenal Stenosis

  • Etiology: Congenital failure of recanalization
  • Imaging AXR: Air fluid levels in stomach and duodenal bulb (double bubble sign) with distal bowel gas
  • Imaging UpperGI: Narrowing after first portion of duodenum
  • DDX: Duodenal atresia, duodenal stenosis
  • Complications:
  • Treatment: Surgical
  • Clinical: Less severe form of duodenal atresia which often results in a delayed diagnosis

Radiology Cases of Duodenal Stenosis

AXR and UGI of duodenal stenosis
AXR (above) shows the tip of the nasogastric tube within a very dilated duodenal bulb. There is extensive distal bowel gas. Spot image from an upper GI exam (below) shows a fixed area of narrowing between the first and second portions of the duodenum through which contrast passed slowly.
UGI of dudodenal stenosis
AXR AP obtained after gastric decompression via nasogastric tube (above) shows gas present through the bowel. AP image from an upper GI exam (below) shows the stomach and first and second parts of the duodenum to be extremely dilated. On a delayed image obtained 15 minutes later, a small amount of contrast was seen to have passed out of the duodenum into the small bowel.

Surgery Cases of Duodenal Stenosis

Surgical image of duodenal stenosis
Surgical image shows a massively dilated second part of the duodenum in the center of the image. The decompressed proximal jejunum, being pinched between the thumb and forefinger, is seen to the left and inferior to the dilated duodenum.