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Duodenal atresia

Fetal medicine

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Duodenal atresia

  1. 1. Duodenal atresia 20150410
  2. 2. Introduction ● congenital disease ● 1/5000-10000 ● 20-40% : Down ● (but 8% in Down) ● 30-52% isolated anomaly ● 20-25% have cardiac anomalies autosomal recessive
  3. 3. Cause ● annular pancreas ● duodenal growth failure failure of recanalization ● biliopancreatic tract or choledochal cysts
  4. 4. Recanalization of duodenum
  5. 5. Classification Type I (duodenal diaphragm) Type II (complete a duodenal atresia) Type III (complete separation of the two ends) annular pancreas 92% 1% 7%
  6. 6. Ultrasound findings ● Polyhydramnios ● "double bubble" Diagnosis 80-90%
  7. 7. Diagnosis ● Polyhydramnios ● abdominal distension ● Bilious vomiting ● "double bubble" sign
  8. 8. Diagnosis ampuIa of vater 90% Bilious vomiting
  9. 9. Treatment ● nasogastric tube ● surgery (duodenoduodenostomy) ● 5% percent morbidity and mortality rate ● Prognosis is usually good ● rare late complications megaduodenum blind loop syndrome duodenogastric reflux esophagitis pancreatitis cholecystitis and cholelithiasis
  10. 10. Differential diagnoses ● late appearing pyloric stenosis ● incomplete diaphragm ● other forms of intestinal atresia ● common mesenteric intestinal volvulus ● duodenal duplication
  11. 11. Differential diagnoses Small Bowel Obstruction duodenal duplication incomplete diaphragm
  12. 12. Syndrome ● Miller-Dieker Syndrome ● Trisomy 21 Teratogens ● Chlordiazepoxide ● Fluorouracil ● Thalidomide
  13. 13. Syndrome ● Miller-Dieker Syndrome ● Trisomy 21 Teratogens ● Chlordiazepoxide ● Fluorouracil ● Thalidomide 利眠寧 治療精神障礙藥物 Cardiac defects Duodenal atresia Microcephaly 服樂癌注射劑 Esophageal and Duodenal abnormalities Radial aplasia 賽得膠囊(沙利竇邁) 治療痲瘋性結節紅斑 Cardiac defects Microtia Duodenal atresia Spine malformations Limb reduction abnormalities
  14. 14. Refference http://www.orpha.net/consor/cgi-bin/OC_Exp. php?Expert=1203 http://en.wikipedia.org/wiki/Duodenal_atresia http://yibian.hopto.org/diag/ill/?illno=811

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