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Neonatal duodenum: fluid-aided US examination.

In 261 infants with vomiting, 11 duodenal abnormalities were diagnosed with fluid-aided ultrasound (US). These abnormalities included duodenal obstruction, malrotation with and without associated volvulus, incomplete rotation, and duodenal stenosis. US was the initial modality used in the evaluation of vomiting in these neonates and young infants. The overall sensitivity and specificity of fluid-aided US evaluation of duodenal abnormalities were 100% and 99%, respectively. (Workup bias limits the reliability of these figures.) Fluid-aided US examination of the stomach and duodenum provided a dynamic view of duodenal rotation and anatomy, and at the very least provided a method of triaging those infants who may require surgery, upper gastrointestinal series, or follow-up US to make a definitive diagnosis.

Duodenal Obstruction↗

A case report of caudal regression syndrome associated with an intraspinal arachnoid cyst.

We report here a rare case of caudal regression syndrome associated with an intraspinal arachnoid cyst. The patient was a 6-month-old baby girl with multicomplex congenital abnormalities: sacrococcygeal dysgenesis and ventral curvature, large terminal cyst (myelocystocele), spinal arachnoid cyst, cerebellar hypertrophy (suspected), high imperforate anus, partial dysgenesis of the large intestine, omphalocele, atresia of the vagina, bilateral incomplete ureter duplication, incomplete pseudoduplicated bladder and bilateral talipes equinovarus. We performed plastic repair of the myelocystocele and perineal lesion for caudal regression syndrome and partial removal of the cyst wall for the intraspinal arachnoid cyst. She has been well for 3 years postoperatively, and her mental development is normal.

Abnormalities, Multiple↗

Pancreas annulare in human embryos.

2 cases of pancreas annulare with duodenal stenosis were found among 3,307 induced abortuses of 5-12 weeks where the pancreatoduodenal area was available for examination. This corresponds to a 0.06% incidence, greatly exceeds the occurrence of the anomaly in neonates and suggests partial prenatal elimination of embryos with pancreas annulare and duodenal stenosis. Microscopic examination of serialed embryonic sections gives evidence of (1) the origin of the ring from the ventral anlage; (2) the underdevelopment of the ring material, which later may cause fibrosis of the annulus, usually observed in neonates; (3) the origin of duodenal stenosis in case of pancreas annulare till 8 weeks of fetal life; (4) the development of such stenosis not only due to atrophy of duodenal segment, resulted from compression by the pancreatic ring, but also due to anomalous differentiation of intestinal segment, the cause of which may be the disturbance of morphogenetic correlations.

Adult↗

Congenital malformations and chromosomal aberrations.

Among a great number of chromosomal aberrations, the absence of cerebral malformations does not explain the reason for mental retardation and will lead to interpreting as normal the echography of a fetus which, after birth, will be revealed to have a trisomy. Trisomic brain anomalies are not constant or obligatory, but some of them (holoprosencephaly for 61% of trisomy-13 and agenesis of corpus callosum for 8% of trisomy-18) have a degree of specificity. As for cerebral and cerebellar heterotopias, they cannot be considered as real malformations as they are frequently found in premature newborns and disappear with maturation, thus proving that they are a sign of immaturity. There is still a lot of work to be done before we are able to meet the request for fetal integrity formulated by contemporary couples.

Brain↗