Duodenal atresia: Difference between revisions
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**AP, lateral, and cross table XR should be obtained on all infants with concern for obstruction | **AP, lateral, and cross table XR should be obtained on all infants with concern for obstruction |
Revision as of 22:06, 23 July 2016
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 Downs syndrome
Clinical Features
Presentation is very early in the postnatal period
History
- Abdominal distention and vomiting
Physical Exam
- Dry mucus membranes, poor skin turgor, and sunken fontanelle
- 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
Differential Diagnosis
- Malrotation with volvulus
- Hirschsprung disease
- Meconium ileus
- 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