A Case Report of Multiple Duodenal Atresia With Y-Shaped Bifurcated Common Bile Duct Termination

Abstract

Multiple duodenal atresia, as well as Y-shaped bifurcated common bile duct termination, is a rare condition. We experienced treating an extremely rare case of double duodenal atresia combined with Y-shaped bifurcated common bile duct termination. A 0-day-old male baby with trisomy 21 and congenital cardiac anomaly, who was suspected of having duodenal atresia without maternal polyhydramnios as prenatal diagnoses, was born by cesarian section in our hospital. Gastric juice mixed with bile was drained with a gastric tube, and abdominal X-ray showed a double bubble sign of gastric and duodenal bulbus. Therefore, we performed surgery under the diagnosis of duodenal atresia. Laparotomy showed separation-type duodenal atresia. Then, for the diamond-shaped anastomosis, a transverse incision at the dilated proximal duodenum and a longitudinal incision at the narrow distal duodenum were made, which revealed both a pinhole without Oddi’s sphincter at the bottom of the proximal duodenum and a membranous atresia in the lumen of the distal duodenum. The membrane was incised, and bile juice spilled out from the proximal lumen of the distal duodenum. We diagnosed the patient as having double duodenal atresia (separation type and membranous type) combined with Y-shaped bifurcated common bile duct termination and performed a diamond-shaped duodeno-duodenal anastomosis after subtotal incision of the membrane in the distal duodenum. Duodenal atresia is not a rare condition; however, we should remember the possibility of multiple atresia or Y-shaped bifurcated common bile duct termination during surgery.