Classification

There are four basic types of duodenal obstruction (Figure 2.4). In type 1 there is a stenosis of the duodenum resulting from a diaphragm or web partially or totally occluding the lumen. Owing to the incomplete nature of the obstruction, cases

Duodenal atresia, duodenal stenosis and annular pancreas are the most common congenital condi-

Malrotation Upper Contrast Study

Figure 2.3 Upper gastrointestinal contrast study of a case of malrotation. The contrast is seen within the duodenum (D) and flowing into the upper jejunum (J), both of which lie completely to the right of the midline.

Figure 2.2 Abdominal X-ray of an infant with duodenal atresia showing the 'double bubble' appearance characteristic of duodenal obstruction.

Figure 2.3 Upper gastrointestinal contrast study of a case of malrotation. The contrast is seen within the duodenum (D) and flowing into the upper jejunum (J), both of which lie completely to the right of the midline.

may present in childhood rather than in the neonatal period. In type 2 duodenal atresia, the proximal and distal segments end blindly but remain connected by a fibrous cord. There is complete separation of the bowel segments in type 3, and type 4 comprises extrinsic obstruction due to an annular pancreas although there may be an associated atretic segment. Multiple atresias are said to occur in approximately 15% of cases.9

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