Duodenal atresia

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

Clinical Features

• Often presents with gastric distension and vomiting
• 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 Downs syndrome

Differential Diagnosis

• Malrotation with volvulus
• Hirschsprung disease
• Meconium ileus
• Intestinal atresia

Nausea and vomiting (newborn)

Newborn	'
Obstructive intestinal anomalies	Esophageal stenosis/atresia Pyloric stenosis Intestinal stenosis/atresia Duodenal atresia Malrotation ± volvulus Incarcerated hernia Meconium ileus/plug Hirschsprung's disease Imperforate anus Enteric duplications
Neurologic	Intracranial bleed/mass Hydrocephalus Cerebral edema Kernicterus
Renal	Urinary tract infection Obstructive uropathy Renal insufficiency
Infectious	Viral illness Acute gastroenteritis Meningitis Sepsis
Metabolic/endocrine	Inborn errors of metabolism Adrenal insufficiency Congenital adrenal hyperplasia
Miscellaneous	Ileus Gastroesophageal reflux disease Necrotizing enterocolitis Milk allergy, FPIES GI perforation

Diagnosis

• Presentation is very early in the postnatal period

• History
  • Often includes history of abdominal distention and vomiting
  • Obtain hx of whether vomiting is bilious or nonbilious and if vomiting follows feeds

• Physical Exam
  • Dry mucus membranes, poor skin turgor, and sunken fontanelle
  • Document signs of other congenital anomalies
  • The abdomen is often markedly distended with visible or palpable loops of bowel.
  • Examine perineum and assess for patency of the anus

Management

• 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

• Treatment
  • NPO
  • NG tube to suction
  • Correct fluid and electrolyte abnormalities
  • Ampicillin and gentamicin (to prevent post-op infection)
  • Surgery

Disposition

• Admission

References

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