Fetal medicine

1. Duodenal atresia
20150410

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. Cause
● annular pancreas
● duodenal growth failure failure of recanalization
● biliopancreatic tract or choledochal cysts

4. Recanalization of duodenum

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. Ultrasound findings
● Polyhydramnios
● "double bubble"
Diagnosis 80-90%

7. Diagnosis
● Polyhydramnios
● abdominal distension
● Bilious vomiting
● "double bubble" sign

8. Diagnosis
ampuIa of vater
90% Bilious vomiting

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. Differential diagnoses
● late appearing pyloric stenosis
● incomplete diaphragm
● other forms of intestinal atresia
● common mesenteric intestinal volvulus
● duodenal duplication

11. Differential diagnoses
Small Bowel Obstruction
duodenal duplication
incomplete diaphragm

12. Syndrome
● Miller-Dieker Syndrome
● Trisomy 21
Teratogens
● Chlordiazepoxide
● Fluorouracil
● Thalidomide

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. 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