Duodenal atresia: Difference between revisions
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*Abdominal distention and bilious [[vomiting|emesis]] within first 24 hours of birth | *Abdominal distention and bilious [[vomiting|emesis]] within first 24 hours of birth | ||
**Abdomen often markedly distended, with visible or palpable loops of bowel | **Abdomen often markedly distended, with visible or palpable loops of bowel | ||
**NG tube aspirate >20 mL | **[[NG tube]] aspirate >20 mL | ||
*Signs of [[dehydration (peds)|dehydration]] (e.g. dry mucous membranes, poor skin turgor, and sunken fontanelle) | *Signs of [[dehydration (peds)|dehydration]] (e.g. dry mucous membranes, poor skin turgor, and sunken fontanelle) | ||
*+/- Signs of other congenital anomalies | *+/- Signs of other congenital anomalies | ||
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==Evaluation== | ==Evaluation== | ||
[[File:DuodenalAtresiaXR.png|thumb|Double Bubble sign]] | |||
*Imaging | *Imaging | ||
**AP, lateral, and cross table XR should be obtained on all infants with concern for obstruction | **AP, lateral, and cross table [[KUB|XR]] should be obtained on all infants with concern for obstruction | ||
**Classic double bubble sign due to dilation of the stomach and proximal duodenum | **Classic double bubble sign due to dilation of the stomach and proximal duodenum | ||
**Absent distal gas | **Absent distal gas | ||
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==Management== | ==Management== | ||
*NPO | *NPO | ||
*NG tube to suction | *[[NG tube]] to suction | ||
*Correct fluid and [[electrolyte abnormalities]] | *Correct [[IVF|fluid]] and [[electrolyte abnormalities]] | ||
*[[Ampicillin]] and [[gentamicin]] (to prevent post-op infection) | *[[Ampicillin]] and [[gentamicin]] (to prevent post-op infection) | ||
*Surgery | *Surgery | ||
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[[Category:GI]] | [[Category:GI]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Surgery]] | |||
Latest revision as of 16:30, 28 October 2019
Background
- During weeks 6 and 7 of gestation, the GI tract becomes occluded then recanalizes during weeks 8 to 10
- Duodenal atresia is thought to result from failure of recanalization
- Often associated with other malformations such as biliary atresia or gallbladder agenesis
- May also be associated with cardiac, renal, or vertebral abnormalities
- About a quarter of patients born with duodenal atresia have Down syndrome
Clinical Features
Presentation is very early in the postnatal period
- Abdominal distention and bilious emesis within first 24 hours of birth
- Abdomen often markedly distended, with visible or palpable loops of bowel
- NG tube aspirate >20 mL
- Signs of dehydration (e.g. dry mucous membranes, poor skin turgor, and sunken fontanelle)
- +/- Signs of other congenital anomalies
Differential Diagnosis
- Malrotation with volvulus
- Hirschsprung's disease
- Meconium ileus
- Other intestinal atresia
Nausea and vomiting (newborn)
| Newborn | ' |
| Obstructive intestinal anomalies |
|
| Neurologic |
|
| Renal |
|
| Infectious | |
| Metabolic/endocrine | |
| Miscellaneous |
|
Evaluation
- Imaging
- AP, lateral, and cross table XR should be obtained on all infants with concern for obstruction
- Classic double bubble sign due to dilation of the stomach and proximal duodenum
- Absent distal gas
Management
- NPO
- NG tube to suction
- Correct fluid and electrolyte abnormalities
- Ampicillin and gentamicin (to prevent post-op infection)
- Surgery
Disposition
- Admission