Presentation
Preterm (34 weeks). Intrauterine growth retardation. Body weight 1.3 Kg. On TPN-IUGR protocol. Abnormal chest and abdomen X-ray after birth.
Patient Data
NG tube is noted in position.
The stomach and proximal duodenum are dilated and gas-filled showing double bubble sign suggestive of duodenal obstruction. No bowel gas is seen beyond the proximal duodenum.
The differential diagnosis includes all causes of duodenal obstruction whether related to intrinsic or extrinsic etiologies.
Barium upper GI study is indicated for further evaluation.
Upper GI study with barium meal given through an NG tube.
No barium material is seen beyond the duodenal bulb indicating duodenal obstruction.
Day 1 post surgical correction.
Gas is seen beyond the duodenum.
Case Discussion
Duodenal atresia is a congenital malformation related to failure of recanalization of the duodenum in early fetal life. Classically it shows the double bubble sign on x-ray with the stomach and proximal duodenum filled with air. The distal bowel loops are not aerated.
Barium upper GI study helps to confirm duodenal obstruction.
Atresia is corrected surgically.
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