During normal fetal development, the duodenum, the upper part of the small intestine, remains unrestricted, allowing stomach contents to flow freely through the baby's digestive tract (Figure 1). Duodenal atresia (DWAH-de-nal ah-TREE-zha) is a condition that occurs when part of the duodenum fails to form. This condition causes a blockage (atresia) that prevents food or liquid from leaving the baby's stomach (Figure 2).
Duodenal atresia can be an isolated condition (meaning that no other birth defect or condition coexists), but it is also more common in babies withDown syndrome(Trisomy 21). About one in three babies born with duodenal atresia have Down syndrome.
Who is on my care team?
At Midwest Fetal Care Center, a collaboration between Children's Minnesota and Allina Health, we specialize in providing individualized care that begins with your own personal care coordinator to help guide your baby's complex care process. We use a comprehensive team approach to duodenal atresia. That way, you can be sure you're getting the best information possible from some of the most experienced doctors in the country. For duodenal atresia, your care team will include a maternal-fetal specialist, pediatric surgeon, neonatologist, geneticist, nurse coordinator, clinical fetal care social worker, and several other technical specialists. This entire team will work closely with you and your baby during the assessment process and will be responsible for designing and implementing your complete plan of care..
Meet the team
What causes duodenal atresia?
Duodenal atresia is a congenital condition, meaning it develops before birth. What exactly causes the condition is unknown, although in rare cases genetics can play a role.
How is duodenal atresia diagnosed?
Duodenal atresia is diagnosed by ultrasonography, but usually not by routine screening ultrasound at 20 weeks. This is because the signs of the disease are not visible on ultrasound until late in the pregnancy.
Ultrasonography leading to the diagnosis is usually performed by one of the following two routes:
- If genetic testing or other diagnostic tests indicate that the baby is at increased risk of Down syndrome, an ultrasound is done to check for duodenal atresia.
- For pregnancies without an increased risk of Down syndrome, an ultrasound is ordered if the uterus is large for dates in the third trimester. An enlarged uterus is sometimes caused by excessive amounts of amniotic fluid, a condition known as polyhydramnios. Extra amniotic fluid can build up if the fetus has difficulty swallowing, a difficulty that can result from duodenal atresia.
The diagnosis is further confirmed when the ultrasound shows the classic sign of duodenal atresia: a "double bubble" in the baby's abdomen. (Figure 3.) A “bladder” is a stomach filled with fluid; the other is the fluid-filled duodenum. These "bubbles" mean that there is fluid in the stomach and part of the duodenum due to atresia (constipation), but not further down the intestinal tract.
What is Down Syndrome (Trisomy 21)?
Down syndrome is a genetic disease. Babies born with this condition have an extra copy of chromosome 21, giving them three copies instead of the usual two. For this reason, Down syndrome is also known as trisomy 21. The extra chromosome interrupts a child's normal course of development, resulting in the physical characteristics and mild to moderate intellectual disabilities associated with the condition. Children born with Down syndrome are more likely to have heart abnormalities, vision and hearing problems, and other health problems. However, due to medical and other advances, today's children with Down syndrome can grow up to live long, happy, healthy, and productive lives.
How is duodenal atresia treated before childbirth?
Prenatal care for babies with duodenal atresia begins with gathering as much information about the condition as early as possible. Tests are also done to determine if you have Down syndrome or a heart-related birth defect. To collect all of this information, we used a variety of techniques, including high-resolution fetal ultrasound, fetal echocardiography, and amniocentesis.
What is High Resolution Fetal Ultrasound?
High-Resolution Fetal Ultrasound is a non-invasive exam performed by one of our ultrasound specialists. The test uses reflected sound waves to create images of the baby in the womb. We use ultrasound to follow the development of the baby's intestinal tract and other internal organs during pregnancy. We will also look for signs of excess amniotic fluid around the baby (known aspolyhydramnios), which may increase the risk of preterm delivery.
What is a fetal echocardiogram?
Fetal echocardiography ("echo" for short) is performed in our center by a pediatric cardiologist (a doctor who specializes in fetal heart defects). This high-resolution, non-invasive ultrasound procedure specifically examines how your baby's heart is structured and functions in utero. This test is important because babies with Down syndrome and duodenal atresia sometimes also have a heart-related birth defect.
What is amniocentesis?
Amniocentesis is a test done during pregnancy to see if the baby has a genetic or chromosomal condition, such as Down syndrome. A small sample of fluid is taken from the amniotic sac that surrounds the baby. The amniotic fluid contains your baby's cells, and these cells contain your baby's chromosomes, which we can analyze. The procedure is simple and can be performed in our clinic. A small needle must be inserted through the abdomen and into the amniotic sac to obtain the fluid sample. It takes several days to process the test results in our lab. The information obtained from this test is very important for creating your care plan and helping the neonatologist to care for your child after birth.
What happens when my assessment is complete?
After collecting all the anatomical and diagnostic information from the tests, our entire team will meet with you to discuss the results. Duodenal atresia cannot be treated before the child is born. However, we will be taking an active, two-pronged approach to managing the condition during pregnancy. First of all, we will monitor the mother and the baby very carefully, looking for possible complications that could lead to a premature delivery. One of these possible complications is the accumulation of extra amniotic fluid (polyhydramnios), which can occur when atresia (constipation) makes it difficult for the baby to swallow. In this case, we will pay close attention to the mother for signs of preterm labor and/or symptoms related to uterine enlargement and pressure. Occasionally, amniorectomy is performed. This procedure, which is similar to an amniocentesis, removes some of the excess fluid and relieves any symptoms the mother may have.
Second, we will try to identify complicating factors such as Down syndrome or a heart defect that may require additional therapies. In this way, we can prepare ourselves during and after birth to provide the best possible care for your child.
How is duodenal atresia treated after childbirth?
Babies with duodenal atresia can be delivered vaginally. Our goal is for your baby to be born as close to the due date as possible. Your baby will be born inThe Mother and Baby Center at Abbott Northwestern and Children's Minnesota in Minneapolisthe enUnited and Children's Minnesota Mother and Baby Center em St. Paul. Children's Minnesota is one of the few centers in the country to have a birthing center within the hospital complex. This means that your baby will be born just a few meters down the hall in our Neonatal Intensive Care Unit (NICU). Many of the doctors you already know are also there during or shortly after the baby is born to provide immediate care.
Your baby will need specialist medical care after birth and will therefore be transferred to our neonatal intensive care unit. Most babies with duodenal atresia will breathe comfortably on their own, but your baby will not be able to breastfeed or use a bottle and will instead be fed intravenously. Because your child's intestines are blocked by atresia, a thin, flexible tube will be inserted into your baby's stomach, either through the nose or mouth. This tube is used to suck out air or fluid that has accumulated in the child's stomach.
Our goal will be to make a definitive diagnosis of duodenal atresia as soon as possible. This diagnosis can be made with a simple X-ray taken shortly after birth. An echocardiogram is also performed to identify a coexisting heart defect.
When will my baby have surgery?
Treatment of duodenal atresia requires surgery to remove the obstruction (atresia) and repair the duodenum. Surgery is not considered an emergency and is usually done when the baby is two to three days old.
Although there are several subtypes of duodenal atresia (Figure 4), the surgical procedure is basically the same for all. The surgeon opens the blocked end of the duodenum and connects it to the rest of the small intestine (Figure 5). The surgeon also inserts a tube from the baby's mouth, through the stomach and into the small intestine. This "feeding tube" is used for the first few weeks after the operation.
The operation is performed under general anesthesia. After that, your baby will go back to the neonatal intensive care unit. For a few days, your baby may need a machine (ventilator) to help him breathe.
How long will my baby stay in the hospital?
Your baby is usually in the hospital for two to three weeks. The feeding tube inserted during surgery is left in place until the small intestine heals, which can take up to two weeks. During the healing process, your baby may be fed breast milk or formula through the feeding tube placed during surgery. Once the cure is confirmed, the baby can start breastfeeding or receive a bottle.
Your baby will be discharged from the hospital if he is eating well and gaining weight.
What is my baby's prognosis?
The prognosis for babies with isolated duodenal atresia is excellent if the condition is diagnosed and treated early.
Does my baby need long-term follow-up care?
Most babies with isolated duodenal atresia do not require long-term follow-up. However, such follow-up care may be needed for babies with the condition who also have Down syndrome and/or a heart defect. These children may also need more surgeries and hospital stays.
contact us
Need a recommendation or more information? You or your doctor can contact the Midwest Fetal Care Center at855-693-3825.
FAQs
What are the symptoms of duodenal atresia in child? ›
- Upper abdominal swelling (sometimes)
- Early vomiting of large amounts, which may be greenish (containing bile)
- Continued vomiting even when infant has not been fed for several hours.
- No bowel movements after first few meconium stools.
Duodenal atresia presents early in life as vomiting, usually occurring within the first 24 to 38 hours of life after the first feeding, and progressively worsens if not treated.
What is the earliest diagnosis of duodenal atresia? ›Duodenal atresia can usually be diagnosed during pregnancy at the second trimester survey ultrasound. An obstetrician (doctor who specializes in pregnancy, childbirth and women's reproductive health) can also diagnosis duodenal atresia if the mother develops polyhydramnios.
What are the features of duodenal atresia? ›Duodenal atresia is typically characterized by the onset of vomiting within hours of birth. Whereas the vomitus is most often bilious, it may be nonbilious because 15% of defects occur proximal to the ampulla of Vater.
What are the signs of duodenum? ›It typically occurs after eating or drinking. Symptoms may include early satiation, uncomfortable fullness, bloating, nausea, vomiting, belching, flatulence, heartburn, regurgitation and diarrhoea.
What causes duodenal ulcers in kids? ›Bacteria called Helicobacter pylori (or H. pylori) cause most peptic ulcers. Using common nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, also can cause a peptic ulcer. The ulcers form when the bacteria or the medicine weakens the mucus that coats the stomach and duodenum.
Can an 8 year old have intussusception? ›Intussusception is the most common cause of intestinal blockage in children between ages 3 months and 3 years. It is rare in newborn babies. But it can also occur in older children, teenagers, and adults. Intussusception is a medical emergency.
What is late presentation of duodenal atresia? ›In most patients with duodenal atresia, signs and symptoms develop early in the neonatal period. On the other hand, in delayed presentations, there is a duodenum with a fenestrated diaphragm called wind sock deformity. A high index of suspicion is necessary to diagnose these conditions at older ages.
What are the long term effects of duodenal atresia? ›The most frequent long-term complications, after the first month, are small bowel obstructions, stenoses and incisional hernias. In duodenal atresia, adhesive bowel obstruction, incisional hernias and gastro-oesophageal reflux disease are described.
Is duodenal atresia life threatening? ›For babies who do not receive treatment for duodenal atresia, it can be deadly. Babies who have surgery to correct the condition typically have excellent outcomes. Some babies have other conditions associated with duodenal atresia, such as Down syndrome.
How do you test for atresia? ›
A pathologist will examine the tissue under a microscope to look for signs of damage or disease. A liver biopsy can show whether an infant is likely to have biliary atresia. A biopsy can also help rule out or identify other liver problems.
What are complications of duodenal atresia? ›Late complications include blind-loop syndrome, megaduodenum with altered duodenal motility, gastritis with duodenal-gastric reflux, peptic ulcer, esophagitis and gastroesophageal reflux, pancreatitis, and cholecystitis.
What is the most reliable symptom of duodenal ulcer? ›Most ulcers are caused by infection from a bacteria or germ called H. pylori (Helicobacter pylori) or from using pain killers called NSAIDs. The most common symptom is a dull or burning pain in the belly between the breastbone and the belly button.
How is duodenal atresia diagnosed? ›How is Duodenal Atresia Diagnosed? Duodenal atresia may be found during routine prenatal ultrasound but sometimes it is diagnosed after the baby is born. If your baby has duodenal atresia, the ultrasound may show fluid in your baby's stomach and part of the duodenum, but no fluid beyond that.
What is a common symptom or complication of duodenal ulcer? ›[7] The pain associated with duodenal ulcers improves after meals, while the pain associated with gastric ulcers generally intensifies after meals. Other common signs and symptoms include epigastric abdominal pain, bloating, nausea and vomiting, and weight gain due to improved symptoms post meals.
How do you fix a duodenum? ›Surgery is still the mainstay of treatment for duodenal perforation. Many perforations are repaired using an omental patch, a technique that was first described by Cellan-Jones in 1929 [6. A rapid method of treatment in perforated duodenal ulcer.
What is the duodenum most concerned with? ›The function of the duodenum is to mix food with enzymes and bile to digest it. The duodenum is a key organ in the gastrointestinal (GI) system because it helps break down nutrients from food to make them available for absorption into the bloodstream.
What happens when the duodenum is blocked? ›If the duodenum is blocked, food can't pass out of the stomach. It builds up in your stomach and makes you feel and be sick and lose weight. This is called gastric outlet obstruction. A tube called a stent can be put into the duodenum to hold it open so food can pass through.
Can a 5 year old get a stomach ulcer? ›Although peptic ulcers are far more common in adults, children of any age can develop these ulcers; without proper treatment, they may experience serious complications, including: Bleeding: As the lining of the stomach or duodenal wall is eroded, blood vessels may also be damaged, causing bleeding.
How do I know if my child has a stomach ulcer? ›Ulcers don't always cause symptoms. The most common symptom is a gnawing or feeling of burning pain in the stomach. This is often felt between the breastbone and the belly button (navel). Your child may feel the pain more between meals, in the early morning, or at night.
Can a 4 year old get an ulcer? ›
Ulcers are far less common in children than in adults. Children who get ulcers oftentimes are taking medicines (such as ibuprofen) which predispose to ulcer formation or are infected with a bacteria that has been shown to sometimes cause ulcers known as Helicobacter pylori.
How do I know if my son has a bowel obstruction? ›The most common symptoms of chronic intestinal pseudo-obstruction in children are nausea, vomiting, abdominal distention and pain, and constipation. Diarrhea, a feeling of fullness even after a small snack, food aversion, and weight loss may also be present.
What are the warning signs of an ulcer? ›- Burning stomach pain.
- Feeling of fullness, bloating or belching.
- Intolerance to fatty foods.
- Heartburn.
- Nausea.
It happens when something irritates the lining of the duodenum. Many things can cause it. These include an infection such as the flu or something you ate or drank. Certain medicines or having a sore (ulcer) on the lining of the duodenum also can cause it.
How can you tell the difference between a stomach and duodenal ulcer? ›Epigastric pain usually occurs within 15-30 minutes following a meal in patients with a gastric ulcer; on the other hand, the pain with a duodenal ulcer tends to occur 2-3 hours after a meal. Today, testing for Helicobacter pylori is recommended in all patients with peptic ulcer disease.
What is the most common site of duodenal atresia? ›The duodenum is the most common site of intestinal atresia. Duodenal atresia and stenosis almost always occur in the region of the ampulla of Vater. Approximately 30% of cases of duodenal atresia are associated with Down syndrome.
How do you fix duodenal atresia? ›Duodenal atresia is treated with a surgery called a duodenoduodenostomy. This is done by connecting the portions of the duodenum before and after the obstruction, effectively bypassing the obstruction. Some types of duodenal blockages may need to be removed surgically.
What are the signs of a blockage in a child? ›Your child may have pain, nausea, vomiting, and cramping. In rare cases, the blockage can cause diarrhea. Complete blockages require a stay in the hospital. Your child may need surgery.
What are the symptoms of obstruction in kids? ›- Crampy abdominal pain that comes and goes.
- Loss of appetite.
- Constipation.
- Vomiting.
- Inability to have a bowel movement or pass gas.
- Swelling of the abdomen.
Intussusception is the most common cause of intestinal obstruction in children who are between 3 months and 6 years old. Boys are affected four times as often as girls.
What is the genetic cause of duodenal atresia? ›
Duodenal atresia can develop from congenital abnormalities that cause either an overgrowth of cells or a lack of blood supply to the duodenum. Duodenal atresia is associated with Trisomy 21, also known as Down syndrome, as well as other intestinal atresias.
How rare is duodenal atresia? ›Duodenal atresia or stenosis is a rare disorder that occurs in approximately 1 of 7,500 live births to 1 of 40,000 live births.
What causes duodenum problems? ›Causes of duodenitis
The most common cause of duodenitis is infection by Helicobacter pylori (H. pylori) bacteria. Another common cause is long-term use of NSAIDs (such as aspirin and ibuprofen). Celiac disease, an allergy to gluten, causes a particular type of inflammation in the duodenum along with other changes.