-         NORMAL







Link to Normal Anatomy




Link to Duodenal Duplication Cysts



Duodenal obstruction, including both stenosis and atresia, is the most common intestinal obstruction in newborns and has an approximate incidence of 1 in 10 000 live births (8). Most obstructions involve the second and third parts of the duodenum and are located close to the orifice of the bile duct (9), and may be associated with numerous etiologies (8-13).

Associated congenital anomalies are found in about 50% of the cases and approximately 30% have trisomy 21 (8, 10-16). Familial cases of duodenal obstruction have been reported and a genetic origin has been discussed (8, 14-16).







Proximal Duodenal Atresia – Down Syndrome




Duodenal Atresia – Second part of duodenum -                                   

Normal karyotype.


Postnatal Upper GI Series:

  • Dilated stomach.
  • Obstruction of duodenum at the level of the proximal third portion.
  • Duodenal web at surgery.





The combination of both conditions is associated with several other conditions:

1.      CHARGE association.

2.      VACTERL association with duodenal atresia (5).

3.      Trisomy 21.

4.      Feingold syndrome (oculodigitoesophago-duodenal syndrome) (6):

-         Microcephaly, tracheo-esophageal fistula and mesobrachyphalangy.

5.      MODED (7): Microcephaly-oculo-digito-esophageal-duodenal syndrome


Duodenal atresia and congenital left sided diaphragmatic hernia (Bochdalek type)





  1. Petrikovsky BM. First trimester diagnosis of duodenal atresia. Am J Obstet Gynecol 1994;171:569-570.
  2. Grosfeld JL, Rescorla FJ. Duodenal atresia and stenosis: Reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long-term follow up. World J Surg 1993;17:301-309.
  3. Akhtar J, Guiney EJ. Congenital duodenal obstruction. Br J Surg 1992;79:133.
  4. Andrassy RJ, Mahour GH. Gastrointestinal anomalies associated with esophageal atresia or tracheoesophageal fistula. Arch Surg 1979;114(10):1125-1128
  5. Muraji T, Mahour GH. Surgical problems in patients with VATER-associated anomalies. J Pediatr Surg 1984;19(5):550-554.
  6. Courtens W, Levi S, Verbelen F et.al. Feingold syndrome: report of a new family and review. Am J Med Genet 1997;73(1):55-60.
  7. Frydman M, Katz M, Cabot SG et.al. MODED: microcephaly-oculo-digito-esophageal-duodenal syndrome. Am J Med Genet 1997;71(3):251-257.
  8. Fonkalsrud EW. Duodenal atresia or stenosis. In Bergsma D, ed. Birth Defects Compendium. New York: Alan R. Liss, 1979: 350
  9. Boyden EA, Cope JG, Bill AH. Anatomy and embryology of congenital intrinsic obstruction of the duodenum. Am J Surg 1967; 114: 190-202
  10. Kirillova IA, Kulazhenko VP, Kulazhenko LG, Lazjuk GI, Novikova IV. Pancreas annulare in human embryos. Acta Anat 1984; 118: 214-7
  11. Merrill JR, Raffensberger JG. Pediatric annular pancreas: twenty years' experience. J Pediatr Surg 1976; 11: 921-5
  12. Young DG, Wilkinson AW. Abnormalities associated with neonatal duodenal obstruction. Surgery 1968; 63: 832-6
  13. Fonkalsrud EW, de Lorimer AA, Hayes DM. Congenital atresia and stenosis of the duodenum. A review compiled from the members of the surgical section of the American Academy of Pediatrics. Pediatrics 1969; 43: 79-83
  14. Grosfeld JL, Rescorla FJ. Duodenal atresia and stenosis: reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long-term follow-up. World J Surg 1993; 17: 301-9
  15. Young DG, Wilkinson AW. Mortality in neonatal duodenal obstruction. Lancet 1966; 2: 18-20
  16. Lawrence MJ, Ford WD, Furness ME, Hayward T, Wilson T. Congenital duodenal obstruction: early antenatal ultrasound diagnosis. Pediatr Surg Int 2000; 16: 342-5
  17. Sase M, Tamura H, Ueda K, Kato H. Sonographic evaluation of antepartum development of fetal gastric motility. Ultrasound Obstet Gynecol 1999; 13: 323-6
  18. Sase M, Nakata M, Tashima R, Kato H. Development of gastric emptying in the human fetus. Ultrasound Obstet Gynecol 2000; 16: 56-9
  19. Levine D, Goldstein RB, Cadrin C. Distention of the fetal duodenum: abnormal finding? J Ultrasound Med 1998; 17: 213-15
  20. Nelson LH, Clark CE, Fishburne JI, Urban RB, Penry MF. Value of serial sonography in the in utero detection of duodenal atresia. Obstet Gynecol 1982; 59: 657-60
  21. Brace RA, Wolf EJ. Normal amniotic fluid volume changes throughout pregnancy. Am J Obstet Gynecol 1989; 161: 382-8
  22.  BrantberAg,  H-G. K. Blaas H-G K,. SalvesenKA  et.al. Fetal duodenal obstructions: increased risk of prenatal sudden death. Ultrasound Obstet Gynecol
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