Duodenal Atresia

Duodenal Atresia


INTRODUCTION:

  • Present a failure of recanalisation of the bowel lumen that is a solid tube early in fetal life (~11-12 weeks).
  • During pregnancy, duodenal atresia is associated with increased amniotic fluid in the uterus, which is called polyhydramnios.
  • After birth, duodenal atresia may cause abdominal distension, especially of the upper abdomen.
  • Duodenal atresia (DA) occur as a result of failure of vacuolization of the duodenum from its solid cord stage. 
  • Bilious vomiting commonly occurs within the first day of life.

Clinical features

  • Duodenal stenosis causing constipation, mucosal web with intact muscular wall (so-called windsock deformity).
  • Two ends separated by a fibrous cord, or complete separation with a gap within the duodenum.
  • The duodenal obstruction is distal to the ampulla of Vater, and infants present with bilious emesis in the neonatal period. In patients with a mucosal web.

ASSOCIATED ANOMALIES

  • Prematurity
  • Down syndrome
  • Maternal polyhydramnios
  • Annular pancreas
  • Biliary atresia.
  • Other  anomalies, such as cardiac, renal, esophageal, and anorectal anomalies, are also common. 

DIAGNOSIS

  • 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. 
    • Appearance of two bubbles visible on x-ray.


TREATMENT

  • Early treatment includes removing fluids from the stomach via a nasogastric tube, and providing fluids intravenously. 
  • The definitive treatment for duodenal atresia is surgery (duodenoduodenostomy), which may be performed openly or laparoscopically

Exam Important

  • Treatment of duodenal atresia is Duodenoduodenostomy
  • Double bubble sign is seen in Duodenal atresia
  • Anomaly associated with duodenal atresia is  Down syndrome
  • A newborn presenting with intestinal obstruction and constipation showed, on abdominal X ray, multiple air fluid levels is suggestive of Duodenal atresia
  • Most common cause of Acute Intestinal Obstruction in neonates is Duodenal atresia
  • Commonest cause of intestinal obstruction in down’s syndrome is Duodenal atresia
  • Antenatal double bubble appearance on ultrasound is due to Duodenal atresia
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