Duodenal Obstruction (neonates)
• Malrotation
• Annular Pancreas
• Duodenal atresia
MALROTATION
• Normal rotation - 2700 Anticlockwise
• Duodenal obstruction due to -
» Ladd’s bands» Volvulus
Annular Pancreas
• Rim of pancreatic tissue encircling 2nd part of duodenum
• Defective rotation and fusion of the ventral and dorsal pancreatic buds
Duodenal atresia
• Failure of canalisation (intrauterine life, 6-7wks)
• Discontinuity in lumen
• Stomach & proximal duodenum dilatation
• Maternal hydramnios, Down’s syndrome
Clinical features
• Bilious vomiting
• Failure to pass meconium
• Visible peristalsis/prominent loops
• No abdominal distention
Volvulus
• Sick child
• Abdominal distention, erythema, tenderness
• Blood in stools
• Plain X ray abdomen :
» DOUBLE BUBBLE SIGN – Duo
atresia
» Gasless abdomen - volvulus
Double bubble sign – duodenal atresia
Malrotation• Barium meal
Absence of C loop of duodenum
DJ flexure to the right of the spine
Jejunal loops on the right side of
abdomen
Sudden cutoff with beaking after 2nd part
of duodenum – volvulus
Malrotation
• Ladd’s operation
» Derotation of volvulus +/- Resection
» Division of Ladd’s bands» Widening of mesentery» Appendicectomy
Duodenal atresia & Annular Pancreas
• Duodenoduodenostomy
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