Two Cases of Congenital Duodenal Atresia With Presence of Distal Bowel Gas

Abstract

We report two cases of congenital duodenal atresia associated with anomalous biliary ducts that permitted communication between the proximal and distal duodenal segments. Case 1 was a 10-day-old boy, who had been tolerating formula feeds until he developed bilious emesis 5 days prior to admission. Plain abdominal radiographs showed a dilated stomach and a small amount of distal bowel gas. Upper GI contrast studies showed a dilated proximal duodenum and reflux of contrast medium into the biliary ductal system. The distal common bile duct communicated with both the proximal and distal duodenal segments. A duodenoduodenostomy was performed and the postoperative course was uneventful. Case 2 was a 1-day-old girl who was admitted for imperforate anus. Plain abdominal radiographs on admission showed copious intestinal gas. After colostomy was performed, she developed bilious emesis. Upper GI contrast studies showed duodenal obstruction with the distal common bile duct communicating with both the proximal and distal duodenal segments. A duodenoduodenostomy was performed and the postoperative course was uneventful. In the case of duodenal atresia associated with anomalous biliary ducts allowing communication between the proximal and distal duodenal segments, clinical presentation may occur later than usual. At the time of repair, surgeons should avoid extensive dissection of the duodenal segments to preserve anomalous biliary ducts.