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Duodenum and duodenal-jejunal junction in children: position and appearance after liver transplantation
E C Benya1, T E Ben-Ami, P F Whitington
1Department of Radiology, University of Chicago, IL 60637, USA.
Insights
Children undergoing segmental liver transplants often show malpositioned duodenums and duodenal-jejunal junctions. Clinical observation is recommended for these pediatric liver transplant patients without bowel obstruction.
Area of Science:
- Pediatric Radiology
- Hepatobiliary Surgery
- Gastrointestinal Imaging
Background:
- Liver transplantation in children is a complex procedure.
- Anatomical variations post-transplant can impact gastrointestinal function.
- Understanding duodenal positioning is crucial for post-operative care.
Purpose of the Study:
- To correlate upper gastrointestinal (GI) study findings of duodenal and duodenal-jejunal junction position in pediatric liver transplant recipients.
- To investigate associations with transplant type, age, indication, and surgical history.
Main Methods:
- Retrospective review of upper GI studies in 23 pediatric liver transplant patients.
- Assessment of duodenum and duodenal-jejunal junction appearance and position by two pediatric radiologists.
- Correlation of imaging findings with clinical and surgical data.
Main Results:
- The duodenum and duodenal-jejunal junction were visualized in 18 children.
- Malposition (elevated and rightward) was observed in 12 children who underwent segmental liver transplantation.
- Normal duodenal and junctional positioning was seen in six children (three whole, three segmental transplants).
Conclusions:
- Malposition of the duodenum and duodenal-jejunal junction is common in children receiving left lobe or left lateral segmental liver transplants.
- Clinical follow-up is advised for these pediatric patients in the absence of bowel obstruction.
Purpose:
To correlate upper gastrointestinal study findings of the position of the duodenum and duodenal-jejunal junction in children after liver transplantation with transplant type, age at transplantation, indication for transplantation, and history of surgery or malrotation.
Materials And Methods:
Upper gastrointestinal studies in 23 children with a liver transplant were reviewed by two pediatric radiologists, and appearance and position of the duodenum and duodenal-jejunal junction were recorded. Findings were correlated with transplant type, age at transplantation, indication for transplantation, and history of surgery or malrotation.
Results:
The duodenum and duodenal-jejunal junction were visualized on anteroposterior spot radiographs in 18 children. In 10 children, the duodenum and the junction were elevated and to the right of the spine; in two, the first and second portions of the duodenum were elevated, but the junction was normally located. These 12 children had undergone segmental liver transplantation. In the remaining six children, the duodenum and junction were normally positioned; three of these children had a whole liver transplant, and three had a segmental transplant.
Conclusion:
The duodenum and duodenal-jejunal junction are often malpositioned in children with a left lobe or left lateral segmental liver transplant. Without documented bowel obstruction, however, these children should be observed and followed up clinically.
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