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The American Journal of Surgery Volume 114 issue 2 1967 [doi 10.1016%2F0002-9610%2867%2990372-8] Edw

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AnatomyandEmbryologyofCongenitalIntrinsicObstructionoftheDuodenum*EDWARDA.BOYDEN,PH.D.,JOHNG.COPE,M.D.,ANDALEXANDERH.BILL,JR.,M.D.,Seattle,WashingtonFromtheChildren’sOrthopedicHospitalandMedicalCenter,andtheDepartmentofBiologicalStructure,Uni-versityofWashington,Seattle,Washington.ThisworkwassupportedinpartbyU.S.P.H.S.GrantHD-656fromtheNationalInstitutesofHealth,Bethesda,Maryland.cONGENITALDUODENALOBSTRUCTIONhasrankedthirdinourhospital,afterim-perforateanusandesophagealatresia,asacauseofintrinsicobstructionofthealimentarytractinnewborninfants.(Fig.1.)Duringthesetwodecadesmoreacceptablesurvivalrateshavebecomeapparent,duepartlytoearlierclinicalrecognitionofthelesionandpartlytomoreeffectivesurgicaltreatmentandapprovedsupportivemethods.Lessattentionseemstohavebeengiventothespecificanatomyandrelatedembryologyofthelesion.Oftentheexactlocationoftheobstructionoritsrelationtotheoriiiceofthecommonbileducthasnotbeenreportedbecausetheinvolvedsegmentisusuallynotopenedbutisbypassedbyanen-teroenterostomy.Furthermore,anobstructedproximalsegmenttendstodilateandelongate,givingtheimpressionthatthesiteofobstruc-tionliesmoredistallyintheduodenumthanitreallyis.Somediaphragmsmayelongatetremendouslyintheformofa“wind-sock”[I]orbeassociatedwithanintraluminaldi-verticulum[Z].Evenwhenautopsyreportsareavailable,detaileddescriptionsareoftenlackingorimprecise.Thepurposeofthisre-port,therefore,istodescribetheanatomyofthisdefectasrecordedinautopsyreportsandspecimensandtorelatethesefindingstotheembryologyoft

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