Minimally Invasive Management of Duodenal and Jejunal Atresia
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Duodenal atresia occurs due to a failure of the lumen to recanalize during the 11th week of gestation. Over half of patients have an associated congenital anomaly with congenital heart disease, trisomy 21, malrotation, annular pancreas, and tracheoesophageal fistula among the most common. The classic presentation is a newborn with early bilious emesis. This finding is dependent on a post-ampullary obstruction, and a small percentage of cases may present with non-bilious emesis due to a pre-ampullary lesion . Prenatal ultrasound often suggests obstruction due to dilated proximal small bowel and polyhydramnios. After birth, the classic imaging finding is the “double bubble” of stomach and duodenal bulb with an absence of distal gas; however, the presence of distal gas does not exclude atresia . Gray and Skandalakis classified the types of duodenal atresia in 1972. Type I defects are the most common and contain a thin membranous separation between the two portions of bowel. In type II, an atretic, fibrous cord connects the two halves, and in type III the segments are entirely separated, and there is an adjacent mesenteric defect .
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