- Patient preparation: none
- Contrast used: low osmolar water soluble or iso osmolar water soluble or barium – never use high osmolar water soluble because if aspirated it can cause severe pulmonary edema, if the clinical picture is highly suggestive for duodenal atresia you may simply inject air
- Technique:
— Insert 8 French feeding tube into the stomach and pass tube transpyloric into the duodenal bulb, with patient in supine position inject 5-10 cc of contrast through the feeding tube to opacify duodenal C-loop and document the position of the duodenal-jejunal junction, flush the tube with sterile saline if it is being left in place, follow contrast through small bowel to level of obstruction
— If feeding tube tip cannot be passed out of stomach then aspirate stomach contents, place patient left side down, inject 5-10 cc of contrast through the feeding tube, turn to right side down to facilitate gastric emptying, when contrast is seen to enter 3rd/4th part of duodenum, turn the patient supine and document the position of the duodenal-jejunal junction, flush the tube with sterile saline if it is being left in place, follow contrast through small bowel to level of obstruction - Images to obtain: AP image of duodenal-jejunal junction, AP image of level of obstruction, consider delayed images to differentiate stenosis from atresia
- Looking for: duodenal atresia, duodenal stenosis, malrotation, midgut volvulus, jejunal atresia, jejunal stenosis
- Post procedure tasks: aspirate the stomach at the end of the exam if feeding tube still in place
Pediatric Imaging 