Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Congenital Obstruction of the Duodenum and Malrotation of the Colon

Congenital Obstruction of the Duodenum and Malrotation of the Colon Congenital Obstruction of the Duodenum and Malrotation of the Colon 1 Simon Dolin , M.D. , Hugh H. Mathews , M.D. and Peter E. Russo , M.D. University Hospitals, 800 Northeast 13th St., Oklahoma City 4, Okla. Excerpt With advances in surgery and the use of the antibiotics, the prognosis of congenital obstruction of the duodenum has become much more favorable. Better understanding of the embryology and pathogenesis has likewise contributed toward a more successful management. Nevertheless, the outcome of surgical correction depends largely on early recognition and on exact diagnosis of the type and degree of obstruction. The purpose of this paper is to present 2 cases of extrinsic congenital obstruction of the duodenum, to discuss the diagnostic problems involved, and to emphasize the possibilities of early roentgen diagnosis of this condition. Case I: T.L.P., a white female infant, was born at the University Hospital on Feb. 10, 1953, and immediately became a feeding problem. She regurgitated each feeding and soon vomited bile-stained material. The family history was not contributory. Physical examination and laboratory studies were not remarkable. A plain roentgenogram of the abdomen revealed a narrowing of the distal end of the third portion of the duodenum, the stomach and the duodenum being well outlined by air (Fig. 1). Gas-filled loops of bowel were seen mostly on the left side of the abdomen. Obstruction of the third portion of the duodenum was suspected. A Lipiodol swallow confirmed this impression and outlined the exact location of the duodenal obstruction (Fig . 2). Barium-enema examination revealed a malrotation of the colon, the cecum and ascending colon being situated to the left of the second vertebral segment, overlying the area of duodenal obstruction (Fig. 3). Preoperative Diagnosis: Extrinsic obstruction of the duodenojejunal junction due to malrotation of the colon. The patient was explored seventy-two hours after birth. At operation (Fig. 6) the stomach and duodenum were found in normal position. The transverse, descending, and sigmoid colon was in normal position. The right colon, however, doubled back on the root of the mesentery, and the cecum and appendix (Fig. 6, B ) were adherent to the mesentery in the region of the ligament of Treitz by a broad adhesive band (Fig. 6, C ) running over the duodenojejunal junction. The duodenum proximal to this level was distended (Fig. 6, A ). The attachment of the root of the mesentery was short, and the greatest part of the small bowel was twisted on the base of the mesentery about 450° in a clockwise direction (Fig. 6, D ). The volvulus was reduced, the adhesive band was freed, and the cecum was placed in the left lower quadrant. The immediate postoperative course was uneventful, and the baby was placed on normal feeding. Case II: T.K., a 13-year-old white boy, was in normal health until three weeks prior to admission to the University Hospital, at which time severe abdominal pain developed, followed by vomiting. After admission on Feb. 19, 1953, the child continued to have abdominal pain of a cramping nature, relieved by vomiting bile-stained material. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

Congenital Obstruction of the Duodenum and Malrotation of the Colon

Dolin, Simon; Mathews, Hugh H.; Russo, Peter E.
Radiology , Volume 63 (1): 85 – Jul 1, 1954
Download PDF
6 pages

Loading next page...
 
/lp/radiological-society-of-north-america-inc/congenital-obstruction-of-the-duodenum-and-malrotation-of-the-colon-vAD2h8zqsU

References (8)

Publisher
Radiological Society of North America, Inc.
Copyright
Copyright © 1954 by Radiological Society of North America
ISSN
1527-1315
eISSN
0033-8419
DOI
10.1148/63.1.85
pmid
13186118
Publisher site
See Article on Publisher Site

Abstract

Congenital Obstruction of the Duodenum and Malrotation of the Colon 1 Simon Dolin , M.D. , Hugh H. Mathews , M.D. and Peter E. Russo , M.D. University Hospitals, 800 Northeast 13th St., Oklahoma City 4, Okla. Excerpt With advances in surgery and the use of the antibiotics, the prognosis of congenital obstruction of the duodenum has become much more favorable. Better understanding of the embryology and pathogenesis has likewise contributed toward a more successful management. Nevertheless, the outcome of surgical correction depends largely on early recognition and on exact diagnosis of the type and degree of obstruction. The purpose of this paper is to present 2 cases of extrinsic congenital obstruction of the duodenum, to discuss the diagnostic problems involved, and to emphasize the possibilities of early roentgen diagnosis of this condition. Case I: T.L.P., a white female infant, was born at the University Hospital on Feb. 10, 1953, and immediately became a feeding problem. She regurgitated each feeding and soon vomited bile-stained material. The family history was not contributory. Physical examination and laboratory studies were not remarkable. A plain roentgenogram of the abdomen revealed a narrowing of the distal end of the third portion of the duodenum, the stomach and the duodenum being well outlined by air (Fig. 1). Gas-filled loops of bowel were seen mostly on the left side of the abdomen. Obstruction of the third portion of the duodenum was suspected. A Lipiodol swallow confirmed this impression and outlined the exact location of the duodenal obstruction (Fig . 2). Barium-enema examination revealed a malrotation of the colon, the cecum and ascending colon being situated to the left of the second vertebral segment, overlying the area of duodenal obstruction (Fig. 3). Preoperative Diagnosis: Extrinsic obstruction of the duodenojejunal junction due to malrotation of the colon. The patient was explored seventy-two hours after birth. At operation (Fig. 6) the stomach and duodenum were found in normal position. The transverse, descending, and sigmoid colon was in normal position. The right colon, however, doubled back on the root of the mesentery, and the cecum and appendix (Fig. 6, B ) were adherent to the mesentery in the region of the ligament of Treitz by a broad adhesive band (Fig. 6, C ) running over the duodenojejunal junction. The duodenum proximal to this level was distended (Fig. 6, A ). The attachment of the root of the mesentery was short, and the greatest part of the small bowel was twisted on the base of the mesentery about 450° in a clockwise direction (Fig. 6, D ). The volvulus was reduced, the adhesive band was freed, and the cecum was placed in the left lower quadrant. The immediate postoperative course was uneventful, and the baby was placed on normal feeding. Case II: T.K., a 13-year-old white boy, was in normal health until three weeks prior to admission to the University Hospital, at which time severe abdominal pain developed, followed by vomiting. After admission on Feb. 19, 1953, the child continued to have abdominal pain of a cramping nature, relieved by vomiting bile-stained material.

Journal

Radiology – Radiological Society of North America, Inc.

Published: Jul 1, 1954

There are no references for this article.