As mentioned previously, bilious emesis in an infant is an operative emergency until proven otherwise. This patients radiograph shows a dilated, air-filled stomach and proximal duodenum (double bubble sign) as well as no gas in the distal bowel. The clinical presentation and radiographic findings are highly suggestive of duodenal atresia.5 The gasless distal intestine in a
1-day old infant could potentially represent intestinal malrotation with proximal volvulus, but the childs benign state with nontender abdomen indicate that volvulus would likely have been a remote in-utero event and would not require emergent operation. Annular pancreas is associated with almost 25% of cases of duodenal obstruction, but typically some air passes into the distal small intestine (unlike duodenal atresia, which is a complete obstruction). Similarly, in jejunoileal atresia, air can pass through the entire duodenum and at least some of the jejunum. Pyloric stenosis does not cause a dilated proximal duodenum as there is no postpyloric obstruction.
- Duodenal atresia
5. Escobar MA, Ladd AP, Grosfeld JL, et al. Duodenal atresia and stenosis: long-term follow-up over 30 years. J Pediatr Surg 2004;39:867-71.
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