ATRESIA DUODENI
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Transcript of ATRESIA DUODENI
dr. Lisa
1st described Calder (1733) 1st successful repair Ernst (1914) Prematurity, growth retardation, coexistent
malformations 50% cardiac, genitourinary, anorectal,
esophageal atresia 30-40% trisomy 21 Down syndrome abn pancreatic tissue, biliary atresia,
agenesis of the gallbladder, stenosis of the CBD
Failure of recanalization partial / complete
Intrinsic webs (perforate/imperforate), atresia, & stenoses
rotation failure of ancreatic ventral anlage annular pancreas
Stenosis, or incomplete obstruction diaphragm/web + small opening
thin web + ballooned distally windsock
Atresia / complete obstruction duodenal muscular continuity or pancreatic tissue filled in gap
Type I, II, III
Plain abdominal x-rays classic “double-bubble” sign dilated stomach & duodenal bulb w/ intraluminal air & fluid, no distal air pattern
Intestinal gas beyond duodenum incomplete obstruction
Contrast meal malrotation & volvulus Air filled biliary tree rare pancreatic &
biliary anomalies Contrast enema inexact for malrotation
Antenatal dilated stomach, duodenum & polyhydramnios (fetal USG 18 weeks)
Perinatal bilious emesis / high gastric aspirates, scaphoid abdomen
Plain abdominal x-rays classic “double-bubble” sign
Gas in the distal segment stenosis, perforate web, Ladd bands
Delayed diagnosis dehydration, hyponatremia, & hypochloremia
Malrotation & Midgut Volvulus
Gastric decompression (NGT) + correction of fluid & electrolyte
USG of the head & urinary tract other anomalies
Echocardiography cardiac malformation Genetic consultation for chromosomal
analysis trisomy / Down syndr? After resuscitation operative correction Urgent surgery if malrotation & volvulus ?
Warming overhead warming lights, warming blanket, 24oC operating room
Transverse supraumbilical incision Inspected for fixated right colon &
rotated ligament of Treitz Malrotation (-) extensive Kocher
(lysis to the mesenteric root) duodenal obstruction + pancreas
Kimura technique a widely patent “diamond-shaped” anastomosis
excessively dilated duodenum weak motility + significantly slower peristaltic frequency stasis & bacterial overgrowth
LaPlace’s Law function & long-term poor emptying improved by reducing diameter
longitudinal axis of antimesenteric wall resection w/ appropriate caliber of catheter in the lumen GI stapler
Op + ICU + parenteral nutrition survival 95%
TERIMA KASIH