The image shows two bubbles on a dark background.
The bubbles as we know are round and filled with
air.
What if you see two such bubbles on a radiograph.
What will you think of??!
YES!! Such a sign in radiograph is called DOUBLE BUBBLE SIGN
Double Bubble sign is a characteristic radiographic finding in DUODENAL ATRESIA.
Normally, during the development of an embryo, the duodenal lumen is canalised,
meaning, the duodenum changes from a solid to a tube-like structure.
In duodenal atresia, there is failure of canalisation of the duodenal
lumen. This leads to congenital absence or complete closure of the distal
duodenum.There is accumulation of gases and secretions above the blockage.
The classic finding on radiograph is the “double bubble sign” which is due
to dilated proximal duodenum and stomach (looks like two
bubbles) associated with lack of bowel gas in the distal part of
duodenum. This can be detected on abdominal X-ray and ultrasound
examination. It can be diagnosed before birth using ultrasound (antenatal
diagnosis).
o Larger, proximal “bubble” is air in a dilated
stomach
o o More distal, smaller “bubble” is air in a dilated proximal duodenum
o There is usually little or no air in the bowel distal to the obstruction
Conditions associated with duodenal atresia:
*Prematurity
(45%), Growth retardation (33%), Down's syndrome-Trisomy
21(30%), Annular Pancreas, Miller-Dieker syndrome
*More than 50% patients have associated congenital anomalies such as Congenital
heart disease (30%), Incomplete rotation of gut (20%), Anorectal malformations
(10%)
Double Bubble Sign - Xray
MORE INFO:
*Duodenal atresia is the most common cause of congenital duodenal obstruction.
*About 30% children with duodenal atresia will have Down Syndrome.
*Bilious vomiting in first several hours of neonatal life is a classic presentation.
*All congenital causes of duodenal obstruction require surgery.
*If left untreated, it is fatal.
*Prognosis will depend on the presence of associated abnormalities.
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