An overview of duodenal atresia (2023)

Duodenal atresia is a rare condition that is present at birth. It is a malformation ofduodenum, which is the section of the small intestine that receives food directly from the stomach. The condition can cause severe vomiting in newborns and also cause some signs during pregnancy, including excess fluid around the growing baby.

symptoms

Prenatal symptoms (before birth)

Duodenal atresia usually leads to polyhydramnios, an abnormal accumulation ofamniotic fluid(the fluid that surrounds the fetus during pregnancy). Under normal circumstances, the fetus swallows amniotic fluid, but when duodenal atresia is present, the fetus has difficulty swallowing, resulting in a buildup of extra amniotic fluid.

Polyhydramnios carries an increased risk of complications during pregnancy, such as B. Preterm labour.

Prenatal symptoms of duodenal atresia include:

• Polyhydramnion:This can make the mother's abdomen appear exceptionally large. A prenatal ultrasound can detect excess amniotic fluid and sometimes alert the doctor that duodenal atresia may be present.
• Doppelblase:This is a classic sign of duodenal atresia seen on ultrasound. One bladder is a picture of the fetus's fluid-filled stomach and the other is a fluid-filled duodenum. These occur when there is fluid in the stomach and part of the duodenum, but no fluid further down the intestinal tract.

symptoms after birth

After birth, babies may have other symptoms of duodenal atresia, such as:

• swelling of the upper abdomen
• Severe vomiting (which may contain greenish-colored bile)
• Vomiting that persists even after withholding formula or breast milk for several hours
• Absence of stool after the first few meconium evacuations. Meconium stool is normal, dark-colored stool that contains the contents that line the intestines during fetal development in the womb.

causes

Normally, the lumen (opening) of the duodenum leads to the rest of the digestive tract. It must be open during fetal development to allow food and fluid to flow freely through the digestive tract as the fetus develops. Duodenal atresia is an obstruction (blockage) of the duodenum due to a developmental malformation. It implies the absence or complete occlusion of the duodenal lumen.

With duodenal atresia, liquids cannot pass through the digestive tract and the baby vomits anything that is swallowed.

Duodenal atresia is a congenital condition that develops before birth. The cause is unknown and genetics may play a role. Duodenal atresia can be an isolated condition or co-occur with other birth defects.

Other associated birth defects include esophageal atresia (an abnormality in the esophagus that affects its mobility), kidney problems, limb defects, heart defects, preterm labor, and other intestinal abnormalities.

Down-Syndrom (Trisomie 21)

Down syndrome is a genetic disorder that occurs when a child has three copies of chromosome 21 instead of two. Down syndrome is known as "Trisomy 21". The extra chromosome causes physical and mental disabilities. Other abnormalities may occur, such as B. duodenal atresia, as well as heart problems, vision problems and hearing problems.

Diagnose

A 20-week prenatal ultrasound scan is often recommended during pregnancy. Duodenal atresia may not be visible on ultrasound until the last trimester of pregnancy.

After the 20-week check-up, an additional ultrasound can be performed.—during the third trimester of pregnancy—for several reasons including:

• genetic screeningsuggesting that Down syndrome is present
• An abnormally large measurement of the uterus during a routine prenatal exam.
• Polyhydramnios or double bladder on the first ultrasound.

If duodenal atresia is suspected, other diagnostic tests may be done, including:

• Retestto check the parents for possible hereditary diseases
• high resolution fetal ultrasound,a non-invasive diagnostic test, can visualize the fetal intestinal tract and other organs
• fetal echocardiography,an ultrasound to evaluate the structure and movement of the heart
• Amniocentesis,a procedure in which a sample of amniotic fluid is taken from the amniotic sac with a long needle inserted into the mother's abdomen to test the fetus' chromosomes for genetic disorders

The definitive diagnosis of duodenal atresia can only be made after birth, when an X-ray can confirm the diagnosis. If duodenal atresia is found, an echocardiogram test is done to evaluate the heart.

Treatment

Treatment of duodenal atresia before birth

Duodenal atresia can only be treated after birth, but there are some prenatal procedures that can reduce the risk of complications at birth.

Close observation is necessary so that the fetus and mother can be monitored for urgent problems. This includes sequential measurements of the uterus and assessment of intrauterine pressure. Sometimes an amniorectomy procedure is performed to remove some of the amniotic fluid during pregnancy.

Treatment of duodenal atresia after childbirth

Babies diagnosed with duodenal atresia may be born normally,sinthe need for a cesarean section. The overall goal is for the mother to have a vaginal delivery as close as possible to the baby's due date. Although labor can be normal, specialist interventions are required after birth and the baby is transferred to the neonatal intensive care unit after birth.

A baby with duodenal atresia needs to be given nutrients and fluids intravenously. In addition, a very thin, flexible tube called a nasogastric (NG) tube is inserted through the baby's nose or mouth into the baby's stomach. This removes the air because trapped air and gases cannot move through the digestive tract normally. The probe also allows fluid delivery to prevent dehydration and provide nutrients.

A baby diagnosed with duodenal atresia may not be able to drink milk from a bottle or breastfeed until surgery is performed to correct the obstruction.

surgical treatment

In most cases, the surgical procedure is performed around the second or third day after birth. Although there are several different types of duodenal malformations that are considered subtypes of duodenal atresia, the procedure for each subtype is similar. The process steps include:

1. administration of general anesthesia
2. Opening the blocked end of the duodenum
3. Connect the rest of the small intestine to the blocked end

after the operation

After the procedure, the baby is returned to the neonatal intensive care unit; The newborn may need to be put on a ventilator (a machine that helps the baby breathe) for a few days.

Under normal circumstances, the baby stays in the hospital for about three weeks after surgery for duodenal atresia. After the surgical site has healed, the baby can start bottle-feeding or breastfeeding immediately. Complications, the baby can go to the parents' home.

forecast

If duodenal atresia is diagnosed and treated promptly, the prognosis is excellent, according to the National Institutes of Health.

Postoperative complications are rare and may include dehydration, small bowel swelling, intestinal motility problems, or gastroesophageal reflux.

Studies in minimally invasive surgery vs. conventional surgery

A 2017 study looked at the outcome of babies with duodenal atresia treated with minimally invasive surgery (MIS) or traditional open surgery between 2004 and 2016.

The results of the study were measured to assess the babies' overall healing time: