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College of Medicine: Department of Radiology

Duodenal Obstruction

Last modified: October 8, 2022
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What is it?

Duodenal obstructions can be caused by duodenal abnormalities (duodenal atresia, duodenal web) or pancreatic pathology (annular pancreas) or they can arise secondary to midgut volvulus. Kids often present with bilious vomiting due to obstruction distal to the ampulla of Vater (85%).

How does it happen?

Congenital duodenal atresia is characterized by developmental failure of duodenal canalization in utero which remains completely obstructed after birth (1, 13) and is associated with Trisomy 13 (Down’s syndrome) & VACTERL syndrome, among others.

What do I need to know?

Characteristic plain film findings include distension of the duodenal bulb and stomach (double bubble sign) with complete ABSENCE of bowel gas distally. Duodenal webs are often fenestrated andare therefore an incomplete form of duodenal atresia (13) which present with double bubble and PRESENCE of distal bowel gas. No further imaging is required to establish the diagnosis.

AP Abdomen X-Ray - showing "Double Bubble" sign
Double Bubble! AP radiograph of the chest and abdomen in this newborn baby beautifully demonstrates the two bubbles of gas in the stomach and duodenum with absence of distal bowel gas.
Lateral Abdominal X-Ray - confirming "Double Bubble" sign
Lateral view confirms the double bubble with distal paucity of air. For bonus points, if you correctly picked up that the enteric tube was too high, yes they do need to advance it a bit further.

References

1. Dunn EA, Olsen ØE, Huisman TAGM. The Pediatric Gastrointestinal Tract: What Every Radiologist Needs to Know. In: Hodler J, Kubik-Huch RA, von Schulthess GK, eds. Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging – IDKD Book. Cham (CH): Springer; March 21, 2018.157-166.

13. Bomer, J., Stafrace, S., Smithuis, R. and Holscher, H., 2020. The Radiology Assistant : Acute Abdomen In Neonates. [online] Radiologyassistant.nl. Available at: <https://radiologyassistant.nl/pediatrics/acute-abdomen/acute-abdomen-in-neonates> [Accessed 2 August 2020].

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