Fig. 5.6. a UGI: determines normal rotation by identifying the duodenojejunal junction (ligament of Treitz). b Intestinal malrotation demonstrated with a barium enema. Localization of jejunum in right upper quadrant. The duodenum does not cross the spine
b a b bulb. In malrotation the duodenum courses into the right upper quadrant and does not cross the spine (Fig. 5.6b) (Carty et al. 2005; Parker 2003; Devos and Meradji 2003; Berrooal et al. 1999).
To avoid the risk of aspiration, the contrast medium is injected in very small proportions ( Devos and Meradji 2003). A contrast enema cannot reliably exclude malrotation as in 15%-20% of normal neonates the caecum has not yet descended, which will occur in the subsequent 6-12 months (Berrooal et al. 1999).
A duodenal web or diaphragm is part of the spectrum from an atretic duodenum to a fully recana-lized duodenum with a central opening. The radiological findings are identical to any other type of duodenal stenosis. The so-called 'windsock' appearance is easy to demonstrate as a curvilinear web that evacuates contrast medium through a tiny small central opening (Fig. 5.7a). The contrast medium is selectively administered through a feeding tube of which the tip is placed in the proximal duodenum (Devos and Meradji 2003).
Annular pancreas with complete or incomplete duodenal obstruction is another cause of duodenal obstruction. Its cause is persistence of the left lobe of the ventral pancreatic bud around the sixth week of gestation that then raps around the duodenum causing a ring-like eccentric narrowing (Fig. 5.7b). The clinical and radiological findings are the same as other types of duodenal obstruction (Carty et al. 2005; Parker 2003; Devos and Meradji 2003; Berrooal et al. 1999).
Duodenal duplication and diverticula are rare and incidentally cause a duodenal stenosis. A cystic non-communicating duplication is easy to detect sonographically while a communicating duplication and diverticulum can only be visualized by gastrointestinal contrast examinations.
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