Knechtle S J, Filston H C
Department of Surgery, Duke University Medical Center, Durham, NC.
J Pediatr Surg. 1990 Dec;25(12):1266-9. doi: 10.1016/0022-3468(90)90527-g.
Duodenal atresia is rarely associated with anomalous biliary ducts that permit communication between the proximal and distal duodenal segments. Two such cases are presented herein and the literature is reviewed. Although the typical radiographic pattern of duodenal atresia is the "double bubble" sign with absence of distal bowel gas, air may be present in the distal bowel when anomalous bile ducts provide a conduit around the atretic segment. Contrast studies are generally not performed in the typical clinical and radiographic evaluation of duodenal atresia; however, an upper gastrointestinal series may be useful in defining the more complex anomaly. Clinical presentation may occur relatively late if the biliary communication is large enough to permit passage of some milk or formula. Care should be taken at surgery to avoid obstruction or injury to the anomalous bile ducts, and operative cholangiography may be useful to document continued bile duct patency following repair of the atresia. Theories of the etiology of this anomaly relate to interference with recanalization of the duodenum by the process of hepaticopancreatic duct formation and persistence of the primitive "dual duct" stage.
十二指肠闭锁很少与允许十二指肠近端和远端节段相通的异常胆管相关。本文介绍了两例此类病例并对文献进行了综述。虽然十二指肠闭锁的典型影像学表现是“双泡”征且远端肠管无气体，但当异常胆管在闭锁段周围提供一条通道时，远端肠管可能会有气体。在十二指肠闭锁的典型临床和影像学评估中通常不进行造影检查；然而，上消化道造影可能有助于明确更复杂的异常情况。如果胆管相通足够大，能够使一些乳汁或配方奶通过，临床表现可能相对较晚出现。手术时应小心避免阻塞或损伤异常胆管，术中胆管造影可能有助于记录闭锁修复后胆管的持续通畅情况。这种异常的病因学理论与肝胰管形成过程对十二指肠再通的干扰以及原始“双管”阶段的持续存在有关。
