Duodenal atresia

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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

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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