title: Bile duct duplication as a cause of distal bowel gas in neonatal duodenal obstruction.
abstract: OBJECTIVE
  The aim of this study is to investigate the clinical characteristics of cases of duodenal atresia (DA) which present with bowel gas distal to a typical double-bubble sign through an anomalous bile duct conduit.
  
  
  METHODS
  Medical records of 57 neonates with duodenal obstruction (atresia or stenosis), presenting with a double-bubble sign and treated at our institute from 1978 to 2010, were retrospectively reviewed.
  
  
  RESULTS
  Thirteen (23%) of 57 neonates presented with bowel gas distal to the double-bubble sign. Passage of gas through the duodenal stenosis may have occurred in 3 cases, whereas in 9 cases, gas may have bypassed the atresia through an anomalous bifurcated bile duct termination and through the pancreatic duct from the accessory to the main pancreatic duct in one case. A preoperative upper gastrointestinal series was performed in 9 cases, and an anomalous bifurcated bile duct conduit was demonstrated in 5 cases. Severe and prolonged cholestasis necessitating evaluation for biliary atresia was found in 2 patients with anomalous bile duct anatomy.
  
  
  CONCLUSIONS
  Neonatal DA presenting with distal bowel gas via an anomalous bifurcated bile duct conduit is more common than initially thought and occurs more frequently than duodenal stenosis. These patients might be at risk for cholestasis, possibly owing to duodeno-biliary reflux through the ampulla.
authors.affiliation: Department of Pediatric Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan. hiro-kom@md.tsukuba.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Komuro
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ono
authors.forename: Noriko
authors.initials: N
authors.lastname: Hoshino
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Urita
authors.forename: Chikashi
authors.initials: C
authors.lastname: Gotoh
authors.forename: Jun
authors.initials: J
authors.lastname: Fujishiro
authors.forename: Toko
authors.initials: T
authors.lastname: Shinkai
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Ikebukuro
mesh_terms: D000015:Abnormalities, Multiple; D001652:Bile Ducts / Q000002:abnormalities* / Q000601:surgery; D001655:Bile Reflux / Q000209:etiology; D001656:Biliary Atresia / Q000150:complications / Q000601:surgery; D004314:Down Syndrome; D004380:Duodenal Obstruction / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005740:Gases; D006330:Heart Defects, Congenital; D059446:Heterotaxy Syndrome; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia; D007422:Intestines / Q000000981:diagnostic imaging*; D007668:Kidney / Q000002:abnormalities; D008297:Male; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D005740:Gases