Combined esophageal and duodenal atresia: sonographic findings

A 39-year-old woman, gravida 4, para 3, abortion 0 had polyhydramnios at about 33 weeks gestation which prompted sonographic examination of the uterus and abdomen. This study demonstrated a large cystic structure in the fetal abdomen, and the patient was referred to our hospital for further evaluation and treatment. Repeat prenatal sonography demonstrated: (1 ) a marked degree of polyhydramnios, (2) an anteriorly placed placenta, and (3) a biparietal diameter of 8.5 cm (consistent with a fetal age of 33-36 weeks). In addition, two large, fluid-filled, cystic structures within the fetal abdomen were demonstrated (fig. 1 ). These structures were believed to represent a distended stomach and duodenal bulb, and the diagnosis of duodenal atresia was suggested. Two weeks later, the mother delivered spontaneously. At birth the infant was active and alert, but the abdomen was grossly distended and a radiograph showed an airless abdomen (fig. 2). In addition, a retrocardiac mass was noted on the left side. After several spontaneous breaths, the infant became distressed and cyanotic and was placed on 100% oxygen. Passage of a nasogastric tube was attempted but could