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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