Windsock Deformity Duodenum

Constipation Infant Radiograph
Figure 2.20. Anteroposterior and lateral radiograph showing a lactobezoar in an infant with die inspissated milk syndrome.

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Figure 2.21. Duodenal atresia observed clinically in an infant at the age of 6 hours. Note the dilated stomach and dilated proximal duodenum giving rise to the "double bubble" appearance. At this early age, the infant also has a scaphoid lower abdomen. Thirty percent of infants with duodenal atresia will have other major anomalies, especially chromosomal abnormalities (e.g., Down syndrome).

Figure 2.22. Radiograph of die same infant as in Figure 2.21 with duodenal atresia showing the classic "double bubble" appearance. Note that there is no gas distal to the obstruction at the duodenum. The opacity in the right lower quadrant represents die soft tissue shadow of the umbilical cord. This shadow is normally obscured in a gas-filled abdomen.

Metobolic Disorder

Figure 2.23. Radiograph of a normal infant at the age of 2 hours. The appearance suggests a "double bubble." This is an artifact as the radiograph was taken through die top of the incubator. The very circular lucency seen in the right abdomen represents the hole in the incubator.

Windsock Deformity Duodenum

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Figure 2.24. Radiograph of an infant with a duodenal web and windsock deformity resulting in the typical "double bubble" appearance. One can see a similar appearance in an annular pancreas causing complete obstruction.

Annular Pancreas

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Duodenal Stenosis Newborn

Figure 2.25. Radiograph of infant with duodenal stenosis. Note the presence of gas distal to the "double bubble." This appearance is also seen in infants with annular pancreas and malrotation with Ladd's bands.

Figure 2.26. Clinical appearance of an infant at the age of 8 hours with jejunal atresia. Note the dilated stomach, dilated duodenum and dilated proximal jejunum giving the typical "triple bubble" appearance. Since jejunal and ileal atresias are due to vascular accidents, they are rarely associated with anomalies.

Figure 2.27. Lateral view of the same infant as in Figure 2.26 showing the typical "triple bubble" appearance. Note the scaphoid appearance of the lower abdomen in the infant at this early age.

Figure 2.28. Radiographic appearance of jejunal atresia showing the typical "triple bubble." The dilated stomach, dilated duodenum and dilated proximal part of die jejunum are easily observed.

Figure 2.29. Barium contrast enema in the same infant with jejunal atresia as in Figure 2.28. Note the "triple bubble" in the background and the microcolon demonstrated by the contrast medium. The microcolon is due to the lack of passage of bowel contents distal to an intestinal obstruction. It may occur in distal jejunal atresia, ileal atresia, or atresia of the proximal colon. Following relief of the obstruction, the caliber and function of the colon are normal.

Figure 2.30. Surgical specimen in an infant with jejunal atresia showing the "Christmas tree" deformity (also called "apple peel" deformity). The loops of small bowel encircle a very short mesentery the way lights are draped on a Christmas tree. Note that there is no intestinal continuity and the proximal jejunum is approximately five times the size of the colon.

Christmas Tree Deformity Bowel

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Infant Abdominal Distention

Figure 2.31. Marked abdominal distension in an infant widi aganglionosis (Hirschsprung's disease) at the age of 4 days. Differential diagnosis includes intestinal obstruction, sepsis (ileus), ascites, and abdominal masses (hydronephrosis, ovarian tumors, etc.).

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Christmas Tree Deformity Bowel

Figure 2.32. Abdominal radiograph of an infant who presented with marked distension and failure to pass stool due to ileal atresia. Note the large dilated loops of bowel. Differential diagnosis includes atresia of the colon and imperforate anus. It may be difficult to differentiate between loops of small and large bowel radiographically in a neonate since haustrations are not present at this early age.

Figure 2.33. Barium enema in the same infant as in Figure 2.32, showing a typical microcolon. Microcolon occurs as a result of lack of passage of bowel contents distal to the obstruction.

Figure 2.34. Barium enema in an infant with a normal colon. Note the difference in the caliber compared to that of a microcolon (Fig. 2.33). Note the isolated dextrocardia.

Isolated Dextrocardia Radiography

Figure 2.35. Abdominal radiograph in an infant who presented at the age of 3 days with massive abdominal distension, lack of stool, and vomiting. This infant has atresia of the colon. Note the large distended loop of bowel in the radiograph on the left. The upright radiograph on the right demonstrates air/fluid levels due to the obstruction. (Singleton, E., Wagner, M.)

Figure 2.35. Abdominal radiograph in an infant who presented at the age of 3 days with massive abdominal distension, lack of stool, and vomiting. This infant has atresia of the colon. Note the large distended loop of bowel in the radiograph on the left. The upright radiograph on the right demonstrates air/fluid levels due to the obstruction. (Singleton, E., Wagner, M.)

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Figure 2.36. Barium enema in the same infant as in Figure 2.35 shows a microcolon with abrupt termination at the splenic flexure, confirming the diagnosis of atresia of the colon. (Singleton, E., Wagner, M.)

Figure 2.36. Barium enema in the same infant as in Figure 2.35 shows a microcolon with abrupt termination at the splenic flexure, confirming the diagnosis of atresia of the colon. (Singleton, E., Wagner, M.)

Microcolon

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Dilating Weeks

Figure 2.37. Appearance of atresia of the colon at surgery in the same infant as in Figures 2.35 and 2.36. Note the large dilated colon proximal to the atresia. Compare diis widi the preceding radiograph in Figure 2.29. Note the distal microcolon. The vascular insult in this infant resulted in complete separation of the proximal and distal segments of die colon. Decompression and colostomy permitted successful re-anastomosis one week postoperatively.

Dilating WeeksTransverse Colon Colonostomy
Figure 2.38. Radiograph of an infant with aganglionosis (Hirschsprung's disease). Massive dilated loops of bowel are seen on the flat plate film on the left and the upright film on the right. Upright films reveal no gas visible in the rectum.(Singleton, E., Wagner, M.)

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Dilated Bowel Newborn

Figure 2.39. Radiograph of another infant with Hirschsprung's disease. Note the markedly dilated loops of bowel, particularly the transverse and descending colon. This infant presented with severe abdominal distension (see Figure 2.31) and delayed passage of meconium.

Figure 2.40. Barium enema of the same infant as in Figure 2.39 showing the gross dilatation of the large bowel proximal to the short aganglionic segment.

Figure 2.41. Oblique view of the barium study in the same infant as in Figures 2.39 and 2.40 better demonstrates the aganglionic segment.

Figure 2.42. Barium enema in an infant of a diabetic mother with the small left colon syndrome. In the small left colon syndrome, there is a microcolon distal to the splenic flexure. Note the lack of haustrations which is normal for an infant. (Singleton, E., Wagner, M.)

Infant Diabetic Mother

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Infant Enema

Figure 2.43. Another example of a barium enema in an infant with the small left colon syndrome. This condition is commonly seen in infants of diabetic mothers. Note the microcolon distal to the splenic flexure. Management of this condition is nonoperative, with slow enteral feedings and total parenteral nutrition support until the colon dilates to a more functional size.

Figure 2.44. Abdominal distension with prominent loops of the bowel in a premature infant. This so-called "pseudoparalytic ileus" of prematurity occurs as a result of poor muscle development in both the abdominal wall and intestinal wall. The infants develop temporary distention with prominent loops of bowel, especially at feeding times. The condition improves with increasing maturity. Persistent distention in a premature infant could be associated widi delay in passing meconium.

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Image Meconium Stool

Figure 2.45. Intestinal obstruction in a term infant. Note the "ladder pattern" of the dilated loops of bowel. Distention and dilated loops of bowel can occur with any type of intestinal obstruction. In this instance they are secondary to a meconium plug. This appearance is pathologic as compared with the "pseudoparalytic ileus" of prematurity.

Figure 2.46. Lateral view of the same infant as in Figure 2.45. Note the abdominal distention and the "ladder pattern" of the dilated loops. Differential diagnosis includes other forms of intestinal atresia or obstruction.

Figure 2.47. Abdominal radiograph of an infant with the meconium plug syndrome. Note the generalized distention due to the dilated loops of bowel and the lack of gas in the pelvis. This would suggest the presence of an obstruction in the distal part of the large bowel.

Meconium Plug

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Figure 2.48. The same infant as in Figure 2.47, after a gentle saline enema, passed a large meconium plug. This meconium plug consists of inspissated meconium which obstructs the bowel lumen. In infants with meconium plug syndrome, the differential diagnosis includes meconium ileus (cystic fibrosis) and Hirschsprung's disease. Meconium plugs have also been reported in infants born to mothers treated with magnesium sulfate for toxemia of pregnancy.

Meconium Plug Syndrome

Figure 2.49. Mucous and meconium plug in an infant. A mucous plug fomis earlier in gestation and is gray to greenish in appearance. This occurs because of lack of bile formation early in gestation. The true meconium plug occurs later in gestation. This figure demonstrates a combination of a mucous and meconium plug. With passage of the plug, die mucous portion of die plug appears first because it develops earlier.

Figure 2.49. Mucous and meconium plug in an infant. A mucous plug fomis earlier in gestation and is gray to greenish in appearance. This occurs because of lack of bile formation early in gestation. The true meconium plug occurs later in gestation. This figure demonstrates a combination of a mucous and meconium plug. With passage of the plug, die mucous portion of die plug appears first because it develops earlier.

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Meconium Plug
Figure 2.50. Pathologic appearance of a large meconium plug in the mid-jejunum. The plug was associated with in-traluminal hemorrhage and colitis. This infant died of necrotizing enterocolitis.

Figure 2.51. Radiographs of an infant with abdominal distention as a result of meconium ileus. Note the opacification of the bowel lumen with relative paucity of air because of the presence of a large amount of inspissated meconium. In infants with meconium ileus, the diagnosis of cystic fibrosis and Hirschsprung's disease should always be excluded. (Singleton, E., Wagner, M.)

Figure 2.52. Differential diagnosis of abdominal distention at birth includes ascites due to multiple causes, meconium peritonitis, and abdominal masses. In this infant the abdominal distention was due to meconium peritonitis, which arises in utero when there is a perforation of the bowel wall with passage of meconium into the peritoneal cavity. The infant also had severe respiratory distress due to pressure on the diaphragm. The classic association is with either perforation and meconium ileus or perforation with bowel atresia. Often no cause is found.

Figure 2.53. Radiograph of an infant with meconium peritonitis. Note the diffuse calcifications in the peritoneal cavity. This is a classic radiographic sign of this condition. As the bowel perforation occurs in utero, on rare occasions the meconium tracks down the inguinal canal into the scrotum and areas of calcification may be seen in the scrotum.

Mecoinum Peritonitis Scrotum

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Figure 2.54. Lateral view of the same infant as in Figure 2.53 with meconium peritonitis. Note the abdominal distention with diffuse calcifications.

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Responses

  • niklas
    Do windsock deformity always have a leak of hole?
    3 years ago

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