In a 7-day-old infant referred because of bile-stained vomiting, jaundice and lack of meconium, radiological examination revealed the 'double-bubble' sign of duodenal atresia as well as dextrocardia. This infant also had a strawberry haemangioma on the right shoulder. Operation disclosed situs inversus and a preduodenal portal vein as well as duodenal atresia. A side-to-side duodeno-jejunostomy was performed successfully without damage to the anomalous vein. The history of polyhydramnion during gestation, the presence of other anomalies, the rapid onset of bile-stained vomiting and the classic 'double-bubble' sign, together appeared to indicate that the duodenal atresia was intrinsic and not due to the external pressure of the anomalous vein on the duodenum.
The installation of the ventriculo-peritoneal shunt (VPS) is on the rise in the pediatric age. Its obstruction is a major cause for further deterioration of the already present hydrocephalus. Distal VPS obstruction may be due to a pseudocyst, an infected pseudocyst or an abscess-formation within the peritoneal cavity. These pathologies are identified through an abdominal radiograph and ultrasonography. The sonographic signs are described and its differential diagnosis is discussed in relation to 6 diagnosed cases. One VPS was obstructed by Ascaris lumbricoides clinging to its tip within an abscess.
Malignant duodenocolic fistula, a rare complication of carcinoma of the hepatic flexure of the colon, may present with bilious diarrhea and feculent vomiting, and is usually associated with severe electrolyte and nutritional depletion. In 2 cases of duodenoenteric fistula caused by recurrence of colonic cancer after right hemicolectomy, the tumor was unresectable. Isolation of the affected intestinal loop, without any attempt at disconnecting it from the duodenum, and diversion of that loop back into the jejunum provided a solution, achieving satisfactory palliation and an improvement in nutritional state.
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