Duodenal atresia is the congenital absence or closure of a portion of the lumen of the duodenum (first part of the small bowel). It is not open and cannot allow the passage of stomach contents.
Causes and associated conditions
The cause of duodenal atresia is unknown, but it is thought to result from problems during an embryo's development in which the duodenum does not normally change from a solid to a tube-like structure. Approximately 20–40% of all infants with duodenal atresia have Down syndrome.
Symptoms
- Upper abdominal swelling may be present
- Early vomiting of large amounts, which may be greenish
- Continued vomiting even when infant has not been fed for several hours
- Absent urination
- Absent bowel movements after first few meconium stools
Diagnosis
The diagnosis of duodenal atresia is usually confirmed by radiography. Duodenal atresia can sometimes be discovered during pregnancy - a fetal ultrasound may show excessive amounts of amniotic fluid in the womb, which is a condition called polyhydramnios. An X-ray of the abdomen shows two large air filled spaces, the so-called "double bubble" sign. The air is trapped in the stomach and duodenum. Since the closure of the duodenum is complete in duodenal atresia, no air is seen distal to the duodenum.
Treatment
A tube is placed to decompress the stomach. Dehydration and electrolyte abnormalities are corrected by providing fluids through an intravenous tube. Surgery to correct the duodenal blockage is necessary, but is not an emergency. The surgical approach will depend on the nature of the abnormality. Duodenal atresia is repaired under general anesthetic in a surgery which lasts about 90 minutes.