Duodenal atresia


Duodenal atresia

Description, Causes and Risk Factor

The duodenum is the name given to the first part of the small bowel and is connected to the stomach. During development the bowel starts as a tube which is then hollowed out. If this process fails to occur a blockage results. This is called an atresia. Atresia's can occur for other reasons such as an interruption in the blood supply to a piece of bowel.

Duodenal atresia

Duodenal atresia is the congenital absence or complete closure of a portion of the lumen of the duodenum. It is not open and cannot allow the passage of stomach contents. Doctors are largely uncertain of the exact causes of duodenal atresia. Most babies who have the condition are born prematurely, and their digestive tracts never fully developed during gestation. The presence of other structural deformities and Down's syndrome are common in infants with duodenal atresia.

It is commonly associated with Down's syndrome, esophageal atresia, and tracheoesophageal fistula. Other associated anomalies include lymphangiomatous cysts of the mesentery, vertebral anomalies, club feet, congenital heart disease, mental retardation, and Meckel's diverticulum. It is also associated with polyhydramnios, which is increased amniotic fluid in the uterus.

Atresias distal to the duodenum are usually caused by vascular accidents or ischemic insult, such as jejunoileal atresia.

Some physician says it occurs while the baby is in the womb and that there is a loss of blood supply to this area in the developing baby. It occurs in approximately one out of 6,000 newborns, and about 25% of duodenal atresia is found in children with Down syndrome.

Babies born with this condition begin vomiting large amounts of material right after birth. The vomit may be green and often is much more than was fed to the infant. One or two initial meconium stools (the first stools of newborns) may be passed, but no further bowel movements occur after that. Without treatment, these babies get very sick very quickly.

Symptoms:

    Upper abdominal swelling may be present.

  • Early vomiting of large amounts, which may be greenish.

  • Continued vomiting even when infant has not been fed for several hours.

  • Absent urination.

  • Absent bowel movements after first few meconium stools.

  • Bile stained vomit after birth.

  • Dehydration.

  • Metabolic acidosis.

Diagnosis:

The differential diagnosis would include pyloric stenosis, other intestinal atresia, midgut volvulus, and sepsis.

The diagnosis is usually made late in the second trimester or early third trimester (6­8months). Although it has been reported as being seen as early as 19 weeks this is very unusual.A fetal ultrasound may show excessive amounts of amniotic fluid in the womb, a condition called polyhydramnios. It may also show swelling of the baby's stomach and part of the duodenum.

The diagnosis of duodenal atresia is usually confirmed by radiography. An X-ray of the abdomen shows two large air filled spaces, the so-called "double bubble" sign. The air is trapped in the stomach and proximal duodenum. Since the closure of the duodenum is complete in duodenal atresia, no air is seen in the distal duodenum.

Treatment:

Treatment Options May Include:

    Tube is placed to decompress the stomach.

  • Dehydration and electrolyte abnormalities are corrected by providing fluids through an intravenous tube.

  • Surgery to correct the duodenal blockage is necessary, but is not an emergency. A surgeon makes a small incision near the navel and inserts a specialized camera to identify the location and nature of the blockage. Surgical tools are used to open the duodenum and suture it to the intestine. During surgery, the infant is usually given a feeding tube and intravenous fluids to prevent dehydration. Followup examinations are important to ensure the procedure was successful and that the baby is digesting nutrients.

Surgery Complications May Include:

    Gastroesophageal reflux.

  • Swelling of the first part of the small bowel (megaduodenum).

  • Problems with movement through the intestines.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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