Dirk Schaper, C. Hess (Klinik für Kinderchirurgie und Klinik für Pädiatrie des Krankenhaus St. Elisabeth und St. Barbara Halle/S.)  

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1 Newborn  

Female  

GI-Duodenum  

congenital  

In the prenatal ultrasound, there is evidence of foreshortened extremities (history of hip dysplasia/chondrodystrophy in the family). Prenatal ultrasound with dilated stomach, double-bubble phenonemon, oligohydramnios. Spontaneous delivery in the 37th week of pregnancy in cephalic presentation. Postnatally unremarkable adaptation. Further diagnostics.  

Internal stenoses arise more often through growth retardation than through vascular or obliterating infections. Beside membrane-like barriers, tubular strictures have been also described.  

<- view X-Ray 1

X-Ray 1: Abdominal overview, hanging. Large stomach bubble in the left upper quadrant, duodenal bubble to the right of the spine, little air in the rest of the abdomen.






<- view X-Ray 2

X-Ray 2: UGI: Contrast media column with abrupt stop at the transition to the pars horizontalis.






<- view Ultrasound 1

Ultrasound 1: Hypoechoic structure with internal floating echos seen in the subhepatic region on the transverse abdominal view.





<- view Ultrasound 2

Ultrasound 2: Obliterating peristaltic waves traveling from the left to right.





<- view Ultrasound 3

Ultrasound 3: Fluid-filled stomach, dilated pylorus, fluid-filled duodenum.


 

Surgery / Histo  

Duodenal atresia, Ladd syndrome, annular pancreas  

Postnatal confirmation of the diagnosis by ultrasound and x-ray. Planned surgical repair using a duodeno-duodenostomy. Intraoperatively, a tubular stenosis was seen, which had a pinpoint sized lumen. A post-stenotic dilation was not seen. A probe could be passed through the lumen. Postoperative pain management with a peridural catheter. Quick oral nutrition through the feeding tube. The tube was removed on the 11th postoperative day and enteral nutrition was unproblematic.  

N/A  

N/A  

1. Medline:
Jürgen Waldschmidt
Das akute Abdomen im Kindesalter
Ed.Medizin, VCH, 1990

2. Medline:
Waldschmidt,J., Charissis, G., Berlien, P., Grasemann, S.
Das Megaduodenum im Neugeborenenalter
Z Kinderchir 30:197-208  

Duodenum, internal, duodenal, stenosis, congenital, duodenal stenosis, internal duodenal stenosis, child, childhood, pediatric radiology  

Dirk Schaper, C Hess. Congenital internal Duodenal Stenosis. PedRad [serial online] vol 5, no. 9.
URL: www.PedRad.info/?search=20050923114058