Duodenal atresia: what it is, surgery, recovery and perspectives (2023)

Overview

What is duodenal atresia?

Duodenal atresia is a condition that some babies are born with (congenital disorder). Babies with duodenal atresia have an obstruction in the first part of thesmall intestine (duodenum). The closure creates a mechanical blockage that prevents the passage of milk and digestive juices.

What is the duodenum?

The duodenum is the first section of the small intestine. After the food passes through the stomach, it enters the duodenum.

What is the difference between duodenal atresia and duodenal stenosis?

Duodenal atresia and duodenal stenosis are congenital obstructions of the small intestine.

Babies with duodenal atresia have a complete obstruction in the first part of the duodenum. Babies with duodenal stenosis have an abnormally narrow duodenum.

How common is duodenal atresia?

Duodenal atresia and stenosis are rare. Globally, only 1 in 7,500 to 1 in 40,000 babies is born with either condition. The conditions affect boys and girls equally.

Who can have duodenal atresia or duodenal stenosis?

Duodenal atresia and stenosis were not associated with environmental exposure. Duodenal atresia is more common in babies with certain genetic conditions.

What other disorders are associated with duodenal atresia?

Nearly 1 in 3 diagnoses of duodenal atresia occur in babies who also have duodenal atresiaDown syndrome. About 1 in 6 babies with duodenal atresia or stenosis who do not have Down syndrome also have it.heart disease, but that number increases to 1 in 2 or 3 babies if they are diagnosed with Down syndrome. Additional abnormalities may occur in 15% or less of patients with duodenal atresia or stenosis, including problems with the bones that make up the spine, esophagus and airways, kidneys, arms or legs, other parts of the intestine and the year

symptoms and causes

What causes duodenal atresia?

Usually during the fifth and sixth week.fetal development, the duodenum is a solid cord. Programmed cell death in the nucleus of the solid cord results in the formation of the normal cavity (lumen) of the duodenum. Failure of this programmed cell death (or "apoptosis") leads to duodenal atresia. Partial completion of the process results in duodenal stenosis or other types of blockages. A baby can also have duodenal obstruction due to a twist in the intestine or pressure from something outside the duodenum, which pushes the duodenum in and collapses it.

What are the symptoms of duodenal atresia?

Most babies develop duodenal atresia within the first few hours after birth.To vomit. The vomit may be yellow, green, or light brown in color. A baby may vomit after the first feeding. If left untreated, the vomiting gets worse. In these cases, it is important to differentiate duodenal atresiabad rotation.

Babies may also experience:

• Low birth weight.
• premature birth.
• swelling in the upper abdomen (tummy).

Patients with a partial obstruction of the duodenum may experience vomiting in infancy if the obstruction is severe enough. Less severe partial blocks can also occur later in childhood. Symptoms that appear later are more varied and include:

• burping
• indigestion.
• Insect.
• Malabsorption.
• abdominal time.

diagnosis and test

How is duodenal atresia diagnosed?

Health professionals can detect duodenal atresia before or after birth.

Prenatally, providers can detect possible duodenal atresia by:

• Fetalultrasonic:These tests can examine the fetal digestive tract. The presence of two "bladders" representing the stomach and duodenum, or just one large gastric ampulla, raises the concern of duodenal atresia or stenosis. Ultrasound may also show elevated levels of amniotic fluid (polyhydramnios). Normally, fetuses swallow and absorb some amniotic fluid in the womb. But a fetus with atresia or duodenal stenosis cannot swallow or absorb amniotic fluid in normal amounts. This can lead to excess amniotic fluid around the fetus.
• Fetal Magnetic Resonance Imaging (MRI):This imaging test may show some findings similar to ultrasound, but may be helpful in determining the extent of atresia if it is not clear on ultrasound.

If duodenal atresia is suspected or prenatally diagnosed, it is important to look for chromosomal abnormalities, such as those associated with Down syndrome. This can be done with amniocentesis or chorionic villus sampling.

• Amniocentesis:This is a test to detect genetic or chromosomal disorders such as Down syndrome. The procedure involves testing a small sample of your amniotic fluid.

Even if providers suspect duodenal atresia before birth, they cannot verify the diagnosis until after the baby is born. After your baby is born, healthcare providers may use:

• Abdominal X-rays:This test looks for air or fluid in the stomach and first part of the intestine. Classically, duodenal atresia shows an enlarged (dilated) stomach and airless duodenum as the intestine progresses. This is called a "double bubble" character. In duodenal stenosis, partial duodenal obstruction, or duodenal atresia with a rare malformation of the bile duct, air can still be seen in the intestine beyond the duodenum.
• Barium swallow tests:This test uses a safe amount of barium (white liquid visible on X-rays) and fluoroscopy (using real-time X-rays to create a film). With this test, suppliers examine superior materialGastrointestinal (GI) tract.. Babies are usually given the barium through a feeding tube (a tube that goes through the nose and into the upper GI tract). This test is most useful in defining partial duodenal obstructions or strictures and looking for other causes of symptoms when there is no definitive diagnosis of duodenal atresia.

management and treatment

How is duodenal atresia treated?

Duodenal atresia is corrected with surgery, but it is not an emergency. Evaluation of associated conditions is important to optimize repair time. Most babies born with duodenal atresia have surgery within two to three days of birth. Some babies may need to have other problems addressed before duodenal atresia.

Before surgery, babies with this condition cannot be breastfed or bottle-fed. Instead, they require parenteral nutrition (feeding intravenously or directly into the stomach). These babies also have a tube inserted through their nose or mouth into their stomach to remove air and fluid trapped in the obstruction.

What types of duodenal atresia surgery are there?

Duodenal atresia is treated with an operation called a duodenoduodenostomy. This is done by connecting sections of the duodenum before and after the obstruction, effectively bypassing the obstruction.

Some types of duodenal obstructions may need to be surgically removed. In rare cases, partial duodenal obstructions can be treated endoscopically with dilation. If the obstruction is caused by compression of something outside the duodenum, surgical repair will depend on the problem identified by your surgeon.

How is the recovery process after duodenal atresia surgery?

After surgery, babies recover in the neonatal intensive care unit (NICU). It can take a week or more for your intestines to wake up and be ready to eat. During this time, a tube is placed to decompress air and fluid from the stomach. Some babies need it tooMechanic ventilationfor a few days to help them breathe.

Babies can leave the hospital when they can take all their food by mouth and gain weight. Babies usually stay in the hospital for two to three weeks. The duration of hospitalization depends on the diagnosis or not of other conditions associated with duodenal atresia.

Can duodenal atresia be treated before birth?

Health professionals cannot treat duodenal atresia until after the baby is born. However, if they find duodenal atresia before birth, they can take additional steps to reduce the risk of birth complications.

For example, excessive accumulation of amniotic fluid can increase the risk of preterm labor. If necessary, your provider may use an amniorectomy. This procedure removes some of the excess amniotic fluid.

Your doctor can also offer prenatal advice and suggest that you deliver at a facility that can care for your baby. This can reduce the age at diagnosis and surgery, reduce the time until the baby can tolerate full oral feedings, reduce the length of hospital stay, and prevent common problems with fluid and electrolyte management.

prevention

How to prevent duodenal atresia?

There is no known way to prevent duodenal atresia. If health professionals detect duodenal atresia during pregnancy, they will carefully monitor it to reduce the risk of complications.

Outlook / Forecast

What is the prognosis for babies with duodenal atresia?

For babies who do not receive treatment for duodenal atresia, it can be fatal. Babies who have surgery to correct the condition often have excellent results.

Some babies have other conditions associated with duodenal atresia, such as B. Down syndrome. These babies may also face other challenges after duodenal atresia surgery. Your baby's care team can help you prepare and know what to expect.

live with

What else should I ask my doctor?

You can also ask your doctor:

• What is the treatment plan for my baby?
• Are there any risks associated with my baby's treatment plan?
• What aftercare does my baby need?
• What signs of complications should I watch out for after surgery?
• What are the chances of having another child with duodenal atresia?

A note from the Cleveland Clinic

With duodenal atresia, babies have a blockage in the first part of the small intestine. This blockage prevents milk and intestinal fluids from passing through the first part of the small intestine. Babies born with duodenal atresia often vomit after the first feeding. Treatment for duodenal atresia is surgery to bypass or remove the obstruction. Babies who receive timely surgical treatment often have excellent outcomes.