TITLE:
Duodenal Atresia-Tandler’s “Epithelial Plug Stage” Revisited
AUTHORS:
Ralf-Bodo Tröbs
KEYWORDS:
Duodenal Atresia, Embryology, Epithelial Plug, Tandler’s Theory
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.9 No.1,
March
28,
2019
ABSTRACT: Background: Duodenal atresia is the most common type of intestinal atresia.
Pathogenesis of duodenal atresia can be explained by an embryological theory
that involves persistent physiologic epithelial occlusion (“epithelial plug”),
first published in 1900. Tandler’s developmental arrest theory has been accepted by the majority of
recognized modern textbooks to date. The aim of the presented study is to
re-evaluate the relevance of Tandler’s observations. Method: Tandler’s
paper was reviewed retrospectively and discussed from the point of view of
subsequent research. Results and Discussion: Local epithelial proliferation, vacuolization failure and mesenchyme
ingrowth may continuously serve as a partly convincing but incomplete
embryologic model to explain membranous duodenal atresia. Tandler’s theory has
some weak points regarding the epithelial-mesenchymal interaction, the predisposition of
the post-ampullary region, the association of duodenal atresia with other
malformations and trisomy 21, and familial occurrence. Shrinkage artifacts,
misinterpretation of a three-dimensional problem investigated with a
two-dimensional tool (light microscope), animal studies, and the lack of
apoptosis call the real existence of a solid stage in early duodenal embryology
into question. Conclusion: More sophisticated morphologic, genetic and molecular-biological
investigations revealed new insights regarding endoderm to mesoderm signaling
as an important key to the pathogenesis of duodenal atresia.