Congenital duodenal obstruction: early antenatal ultrasound diagnosis.
Twenty-nine patients with congenital duodenal obstruction (DO) detected as a "double bubble" (DB) on antenatal ultrasound (US) or diagnosed postnatally were seen at the Women's and Children's Hospital between 1985 and 1994; 24 (83%) had antenatal scans, with 21 (87%) DBs visualised. The 3 fetuses with normal scans who developed DO postnatally had duodenal "windsocks". Five of the 24 scanned patients (21%) were found to have a DB before 20 weeks' gestation: 1 simple duodenal atresia, 2 duodenal atresias with chromosomal abnormalities (1 trisomy 21 and 1 triploidy), 1 biliary atresia with a pre-pyloric vein, and 1 malrotation. Sixteen (67%) cases were detected with scans after 20 weeks (range 28-36 weeks); 12 (75%) of these were done for polyhydramnios. In response to a questionnaire to 9 of the 16 parents whose fetuses underwent a late scan, 5 had had normal early scans elsewhere and 4 did not respond (4 of the remaining 7 had died and 3 were lost to follow-up). Eleven of the 29 patients (38%) had abnormal karyotypes, and 4 (22%) of the 18 with a normal karyotype had associated anomalies. Two sets of familial cases were noted. Early antenatal diagnosis of DO is possible in a minority of cases, and this early diagnosis may be associated with an increased risk of other pathology. Furthermore, early demonstration of a DB at routine US prior to 20 weeks allows appropriate counseling and the option of mid-trimester termination, whereas this is more difficult later in the pregnancy. In all cases detected antenatally, planning of delivery and parent counseling should be achieved.
Lawrence
M J
MJ
Department of Paediatric Surgery, Women's and Children's Hospital, North Adelaide, South Australia.
Ford
W D
WD
Furness
M E
ME
Hayward
T
T
Wilson
T
T
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging* / Q000235:genetics; D004380:Duodenal Obstruction / Q000150:complications / Q000151:congenital* / Q000000981:diagnostic imaging* / Q000235:genetics; D005260:Female; D005817:Genetic Counseling; D006801:Humans; D007231:Infant, Newborn; D007621:Karyotyping; D008297:Male; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016216:Ultrasonography, Prenatal / Q000379:methods*