[size=20px]A 3 year old child with trisomy 21 and a history of duodenal atresia presents to your office. She had a gastrostomy tube placed at birth for failure to thrive and is currently tolerating her feeding regimen. She recently presented in the emergency room for a dislodged gastrostomy tube. Following replacement, a study was obtained confirming placement. The radiologist reports that the gastrostomy tube is well positioned, with a persistently dilated proximal duodenum. The best next step in management with regard to the persistently dilated duodenum is?

 

A Upper GI endoscopy

 

B MR enterography

 

C Gastric emptying study

 

D UGI with small bowel follow through

 

E Observation​[/size]

D.

you know I am an old fashion

A Endoscopia

UGI with small bowel follow through

D) UGI with small bowel follow through

 

This imaging study will provide further information about the anatomy and function of the duodenum and surrounding structures, helping to assess the cause of the persistent dilation.​

C

D

E

D

D

Possible duodenal web

Missed before or stricture

D

D

D

correct answer

E Observation​​

 

Duodenal atresia is a common cause of newborn intestinal obstruction occurring in more than one in ten thousand births. Associated congenital anomalies include trisomy 21, cardiac anomalies and Hirschsprung disease. Long term follow-up of these patients show that most patients are asymptomatic following repair. Endoscopic and radiologic findings have found that duodenal dilation may persist years after the procedure even in patients without symptoms. It should be noted that there is a poor correlation between symptoms and radiologic and/or endoscopic findings. The megaduodenum may fail to return to normal caliber and duodenogastric reflux and duodenal dysmotility may persist decades after the initial surgery in asymptomatic patients. Therefore, symptoms should dictate whether follow-up studies or surgery is required.

 

Up to 12% may develop late complications such as duodenal stasis or poor motility in the dilated segment. Some of these patients may require anterior or lateral duodenal plication. Less than ten percent require revision of the anastomosis.

 

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[size=20px]A 3 year old child with trisomy 21 and a history of duodenal atresia presents to your office. She had a gastrostomy tube placed at birth for failure to thrive and is currently tolerating her feeding regimen. She recently presented in the emergency room for a dislodged gastrostomy tube. Following replacement, a study was obtained confirming placement. The radiologist reports that the gastrostomy tube is well positioned, with a persistently dilated proximal duodenum. The best next step in management with regard to the persistently dilated duodenum is?

 

A Upper GI endoscopy

 

B MR enterography

 

C Gastric emptying study

 

D UGI with small bowel follow through

 

E Observation[/size]

E

D

Persistent proximal duodenal dilatation following duodenal atresia repair may reflect megaduodenum with impaired motility or a mechanical obstruction, such as an anastomotic narrowing. A UGI study with small bowel follow-through evaluates the postoperative anatomy, passage through the anastomosis, and downstream contrast transit, helping distinguish these possibilities.