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