1. 1. Desarrollo de Intestinos Duodeno Yeyuno leon
2. 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. 3. Lnea medial lado derecho y atrs .
4. 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. 5. Desaparece el mesenterio del colon ascendente. El mesenterio del intestino delgado abanico (ngulo duodenoyeyunal orificio ileal).
6. 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. 7. Fijado a la saco vitelino por el conducto onfalomesentrico pared posterior por mesodermo dorsal (corto)
8. 8. Semana 5 Alargamiento en forma de horquilla. Formacin de un asa intestinal con rama ceflica y caudal.
9. 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. 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. 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. 12. CASOS CLNICOS I II III IV
13. 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. 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. 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. 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.