Duodenum complete obstruction

The bile flow is interrupted in its passage from the porta hepatis to the duodenum as a result of (i.) intraluminal obstruction, (2.) obliterating disease of the biliary duct walls, or (3.) compression of the extrahepatic efferent bile ducts. This form of cholestasis can be sudden in onset or progress slowly, may be transient or persistent, and occurs either as incomplete or complete obstruction with jaundice, (s. tab. 13.2) (s. figs. 8.12, 8.13 25.8)... 

Midgut volvulus is the most dramatic consequence of intestinal malrotation. When present at birth, the classic finding on a plain film is partial obstruction of the duodenum, but evidence of complete obstruction may also be present. In such cases, it is impossible to distinguish midgut volvulus from... 

Fig. 1.5a-c. Annular pancreas. Supine (a) and lateral (b) views of the abdomen show complete obstruction at duodenal level identical to that seen in duodenal atresia. The stomach (st) and duodenal bulb (d) are distended and there is no distal air. c Surgical image shows the pancreatic tissue (arrow) encircling the duodenum (d)... 

Fig. 1.11a,b. Midgut volvulus in a 7-day-old girl with bilious vomiting. Upper gastrointestinal series. Anteroposterior (a) and lateral projections (b). The distal duodenum courses anteriorly and tapers to a beaked obstruction (arrow). No contrast is observed beyond the obstruction, but there is distal air indicating a recent complete obstruction... 

Fig.4.6a,b. Duodenal obstruction by adenocarcinoma, a Sagittal sonogram of the right upper abdomen discloses a mass (arrows) with dilated first part of the duodenum (d). b Upper gastrointestinal series shows near-complete obstruction by adenocarcinoma (arrows)... 

Fig. 1.3. Complete duodenal obstruction caused by a congenital duodenal web. The stomach (st) and duodenum (d) are dilated and with absence of air more distally in the gastrointestinal tract, producing the classical double bubble image...

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... 

Superior mesenteric artery (SMA) syndrome is an uncommon but well recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum against the aorta by the SMA, resulting in chronic, intermittent or acute complete or partial duodenal obstruction. Clinical symptoms are chronic upper abdominal symptoms such as epigastric pain, nausea, vomiting (bilious or partially digested food), postprandial discomfort and sometimes subacute small bowel obstruction. The stomach can be massively dilated and perforation has been described (Carty et al. 2005 Parker 2003). 

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