2. DUODENO Organognesis (4 -13 semanas) De la parte terminal
del intestino anterior, inicial del intestino medio y mesnquima
esplcnico. Conducto coldoco Divisin aparato digestivo superior e
inferior. * Irrigacin
3. Lnea medial lado derecho y atrs .
4. Semana 5 y 6 El epitelio de revestimiento prolifera y
oblitera la lu Recanalizacin al inicio del periodo fetal.
Desplazamiento pared abdominal post. Fusin del mesoduodeno dorsal +
peritoneo adyacente = Fascia retroduodenopancretica *Slo la regin
del ploro queda intraperitonealmente.
5. Desaparece el mesenterio del colon ascendente. El mesenterio
del intestino delgado abanico (ngulo duodenoyeyunal orificio
ileal).
6. YEYUNO E LEON * Flexura duodenoyeyunal (*) unin ileocecal. 6
7 m de largo 2 4 cm de dimetro Sin lnea de demarcaci Intestino
medio
7. Fijado a la saco vitelino por el conducto onfalomesentrico
pared posterior por mesodermo dorsal (corto)
8. Semana 5 Alargamiento en forma de horquilla. Formacin de un
asa intestinal con rama ceflica y caudal.
9. Semana 6 Formacin de la hernia umbilical fisiolgica ( celoma
intraembrionario) por espacio insuficiente en la cavidad abdominal,
el crecimiento del asa intestinal, hgado y riones. Rotacin de 90
antihoraria (eje: mesentrica superior. Rama ceflica derecha Rama
caudal izquierda Rama ceflica porcin distal del duodeno, yeyuno e
leo. Rama Caudal resto del leon, ciego, apndice vermiforme y pte
del colon.
10. Semana 9 y 10 Giro de 180 y reinsercin en la cavidad
abdomina 90 reg ceflica + 90 reg caudal Fin de la herniacin
fisiolgica Regresin del rin mesofrnico Disminucin del crecimiento
del hgado Expansin cavidad abdominal. 1 Prox yeyuno colon caudal
(arriba/izq) 2 Distal yeyuno/leon (centro/der) 3 Rama caudal ( fosa
iliaca izq)
11. Semana 7 - 10 Inicio de diferenciacin epitelial (patrn
cefalocaudal) Vellosidades intestinales (endo-meso/esplac) Pliegue
mucosa y submucosa vellosidades Mucosa Ep. cilndrico simple +
microvellosidades Microvellosidades desembocan las criptas o
glndulas de Lieberkuhn. Semana 12 Las criptas muestran lumen con
clulas cilndricas simples indiferenciadas. Cel absorcin Cel
caliciformes Cel Paneth Cel Endocrinas Al madurar migran a las
vellosidades.
12. CASOS CLNICOS I II III IV
13. Estenosis Duodenal Obstruccin incompleta de la luz. Debido
a recanalizacin incompleta de la tercera y cuarta porcin del
duodeno. This 35-year-old primigravida, who had undergone
in-vitro-fertilization with two- embryonic transfer, came to our
department at 13th, 22nd and 33rd week of pregnancy. We discovered
a triplet pregnancy (one monochorial monoamniotic fetus and two
monochorial biamniotic fetuses). The first and second ultrasound
screening were normal. At 33-week of pregnancy the patient was
admitted to our hospital due to premature uterine contractions with
cervical dilatation at 3 cm. The ultrasound investigation revealed
intrauterine growth restriction one of the monochorial monoamniotic
fetus with an anechogenic structure near stomach (double bubble
sign). The other two fetuses were normal. Two days after patients
admitting the cesarean section was performed because of
intensifying of premature contractions. Postnatal finding confirmed
the diagnosis of duodenal stenosis of the fetus mentioned above.
The karyotype was normal. Afflicted baby underwent laparotomy with
normal postoperative course. Transversal abdominal view with
"double bubble" sign.
14. Atresia Duodenal Oclusin total del duodeno. 20-30%
asociados al Sndrome de Down. Falta total de recanalizacin a II y
III porcin del duodeno. General polihidramnios Signos = distencin
abdominal y vmitos (+bilis)
15. Case report This is a case of a 22-year-old G2 P1 who came
to our department for the ultrasound scan at 36 weeks of gestation.
Ultrasound revealed an increased amount of the amniotic fluid and
"double-bubble" sign, typical for duodenal atresia. No other
abnormalities were detected during the examination. Patient
delivered at 38 weeks and duodenal atresia was confirmed after
delivery. Neonate underwent surgery and is doing well. Images 1,2:
Transverse view of the stomach (St) and duodenum (D), both stomach
and duodenum are dilated due to duodenal atresia, characteristic
"double-bubble" sign.
16. Images 5,6: Image 5 shows a fetal profile. Image 6 shows
male sex and increased amount of the amniotic fluid characteristic
for duodenal atresia.