Talk:Paper - Case of abnormal duodenum (1924)

CASE OF ABNORMAL DUODENUM

By W. W. WAGSTAFFE, O.B.E., F.R.C.S. Demonstrator of Anatomy, University of Oxford.

Tue abnormality here recorded was observed in the dissecting room, Oxford University in January, 1923, in a man aged about 56 years, who had died of no trouble in connection with his alimentary tract. The condition is reported as being of some interest from the developmental point of view, and also

because of its rarity. DESCRIPTION

1st part. Normal. 2nd part. Vertical in position and containing openings of bile duct and

pancreatic duct separate but situated about the normal level. The relations and arrangements are normal except for its posterior relation. At its lower extremity it turns abruptly and directly backwards and passed into

Duodenum | part Pylorus

Q

sy

Duodenum V4 24 part Gall. . Bladder

Duodeno- jejunal junction

rd 5 3™part Superior. indicat Mesenteric site of Vessels

Papilla of = Vater = =| Aorta | =f HY TT = Inferior

Vena Cava Case of Abnormal Duodenum 179

8rd part. ;

(a) Vertical limb runs up parallel with and behind 2nd part and is approxi- mately of the same length. It is in close relation with the liver and neck of gall-bladder. After a course of approximately 3 ins. it turns sharply to the left passing into

(6) Transverse portion (vide diagram). This runs transversely and some- what downwards to reach the duodeno-jejunal junction which is situated in about the normal position on the left side of the body of the 2nd lumbar vertebra.

Common Bile Duct

Pylorus Renal Artery L.

Superior Mesenteric A

Duodeno-jeyunal Junction

Renal ArteryR. Fig. 2

In its course this part of the duodenum passes behind the neck of the pancreas and under the superior mesenteric vein and artery. The common bile duct also lies in front of this portion. It lies directly in front of the left renal vein crossing that vessel and the aorta.

Between the upper end of the 2nd part on its right and posterior aspect and the upper end of the vertical limb of the 3rd part on its right and anterior aspect there stretches a firm band approximately }in. long, fin. wide, and 7 in.

thick. REMARKS

The condition is a developmental one and is apparently due to rotation of the duodenum loop through a complete half-circle in the clockwise direction. The cause of this is not obvious and it is a question what part if any the band of adhesions noted between the 2nd part and the vertical loop of the 3rd part has played in the production of this condition. Possibly the band is a purely secondary condition.

The condition has been described by S. V. Telfer) and by J. H. Ander- son(2). I can find no other reference to the condition.

I am indebted to Professor Thomson for permission to publish this note and for his whole-hearted assistance especially in the preparation of the figures.

REFERENCES

(1) Tzurmr, 8. V. “A case of abnormal disposition of peritoneum.” Journ. Anat. xix. 136. 1914-15. (2) AnpzRson, J. H. “Abnormalities of the Duodenum.” Brit. Journ. Surg. x. 316. 1923.