The position and mobility of the duodenum in children

Abstract

Nine criteria were identified as a useful means of detecting subtle abnormalfties of duodenal position.The normal duodenojejunalfiexure was found to be readily displaceable in neonates and could be pushed to the right of the spine in over two- In the control group, barium was administered orally or via a nasogastric tube in a right lateral position.Upon initial barium accumulation in the bulb and second duodenum, the patient was rolled supine. Posteroanterior camera spot radlographs were obtained rapidly (in Downloaded from www.ajronline.org by 54.202.233.140 on 05/12/18 from IP address 54.202.233.140.

Bilious vomiting in the newborn: how often is further investigation undertaken?

“…The position of the duodenal-jejunal flexure shows some variability in the neonate [8], and the ramifications of a false-positive finding would be unnecessary surgery. A prospective study of upper GI contrast studies in all babies with bile vomiting would help further investigate this question.…”

Intestinal malrotation – volvulus: Imaging findings

“…6,9 The rest is fixated to the retroperitoneum and barely moves. 3 In the anterior---posterior projection the duodenum---jejunal junction is usually located to the left of left vertebral pedicles at the level of the inferior margin of duodenal bulb or pylorus, 2,3,7,9,16,24,25 at the level of the left pedicle of L1 but never again medial. 3,25,26 The location of duodenum in the lateral projection is posterior with one parallel orientation in the 2nd and 4th sections always above the superior plateau of the L2 vertebral body 6,7,24---26 (Fig.…”

“…6---8,26 Displacement is possible thanks to the suspensory muscle of duodenum making up the Treitz ligament and including smooth and skeletal muscular fibers. 25 Malrotation should be taken into consideration in patients with an unusual redundant duodenum and differentiation can be made from normal variants like the M-shaped duodenum---also called ''wandering duodenum''. 3,6,7 The isolated location of proximal jejunum on the right section of the abdomen is not indicative of malrotation per se and this is why it needs to be accompanied by other suggestive findings.…”

Imaging of Malrotation in the Neonate

“…The DJJ is readily displaced to the right of the spine in more than two-thirds of infants, but mobility of the DJJ decreases with age. 23 The second segment of the duodenum may be redundant, referred to as a "wandering duodenum." The proximal jejunum is almost always in the left side of the abdomen, but rarely can actually be in the right upper quadrant.…”