19 Duodenal Narrowing or Obstruction

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GI 19-1 Duodenal atresia with double-bubble sign. The left bubble (open arrow) represents air in the stomach; the right bubble (solid arrow) reflects duodenal gas. There is no gas in the small or large bowel distal to the level of the complete obstruction.

Fig GI 19-2 Congenital duodenal stenosis. The presence of small amounts of gas distal to the obstruction indicates that the stenosis is incomplete.

• Fig GI 19-3 Duodenal diaphragm. The presence of gas in the bowel distal to the diaphragm indicates that the high-grade obstruction is not complete.

Fig GI 19-4 Ladd's bands. Obstruction of the third portion of the duodenum (arrow) in a newborn infant, due to dense fibrous bands.

• Fig GI 19-5 Postbulbar ulcer. The deep incisura associated with the medial wall postbulbar ulcer (arrow) causes severe narrowing of the second portion of the duodenum.

Fig GI 19-6 Crohn's disease. Severe postbulbar narrowing with distal fold thickening.

• Fig GI 19-7 Chronic pancreatitis with acute exacerbation. The inflammatory mass narrows the second portion of the duodenum and causes marked mucosal edema and spiculation (arrow).

Fig GI 19-8 Pancreatic pseudocyst. Although there is narrowing of the second portion of the duodenum with widening of the duodenal sweep, the mucosal folds are intact.

• Fig GI 19-9 Carcinoma of the pancreas producing an annular constricting lesion (arrow). The radiographic appearance is indistinguishable from that of primary duodenal carcinoma.

• Fig GI 19-10 Intramural duodenal hematoma. High-grade stenotic lesion (arrow) that developed in a young child, who had been kicked in the abdomen.

• Fig GI 19-11 Superior mesenteric artery syndrome in scleroderma. There is severe atony and dilatation of the duodenum proximal to the aorticomesenteric angle (arrow).