Duodenal Atresia

What is duodenal atresia?

The duodenum is the first part of the small bowel. Duodenal atresia occurs when there is an blockage within the first part of the small bowel. Approximately one third of those diagnosed with duodenal atresia also have Down syndrome and/or coexisting cardiac anomalies. It can also be associated with other birth defects.

Symptoms

  • Duodenal atresia is often characterized by a “double bubble” on prenatal ultrasound. One bubble represents air in the stomach and the other bubble represents the first part of the duodenum, with no air past that. 
  • If the baby is not diagnosed prenatally, he/she is usually diagnosed hours after birth with vomiting. It can be bilious or non-bilious vomiting. 
  • This is often diagnosed prenatally on ultrasound or on an x-ray after the baby is born.

How is it treated?

Initially a small tube, called a nasogastric (NG) tube is placed through the child’s nose and into the stomach allowing it to decompress, draining air and fluid. The baby is started on intravenous fluids to correct dehydration and electrolyte abnormalities. Surgery is required to treat duodenal atresia, usually within the first few days of life. Once the child is taken for surgery, a small incision is made over the stomach and the blockage in the small intestine is located. This area will be opened up and connected to the area of the small bowel past the blockage. This allows the digestive tract to function.

In patients with a coexisting heart defect, a gastric tube (g-tube) may be inserted at the time of surgery for feeds.

What will happen in the hospital?

After surgery your child will remain in the hospital. He or she will have steri strips over the incisions.

The NG tube will remain in place for several days. Many times a contrast study will be performed to document that the repair of the duodenum is functioning well. This occurs 5 -7 days after surgery. Contrast dye will be put in the nasogastric tube and x-rays taken to confirm the passage of the dye from the stomach through the repaired duodenum in to the remainder of the intestine. Feedings will not be started until there is return of bowel function. This usually occurs in 2-3 weeks. Your child will remain on intravenous fluids and will also have intravenous antibiotics.

Pain will be controlled with Tylenol. Occasionally patients require a stronger intravenous pain medication such as morphine in the early postoperative period. Some babies require intravenous nutrition, which is feeding through a peripherally inserted central catheter (PICC) line.

When will my child be discharged?

Once he or she is able to tolerate feedings, without vomiting. Tolerating full feedings can take several weeks and your child will be monitored to ensure they are gaining weight.

What will be my child's recovery?

The majority of recovery takes place in the hospital, as he or she will remain in the hospital for several weeks.

What should I be looking for after the operation and hospitalization?

  • No stooling
  • No urinating
  • Poor feeding or not at all
  • Vomiting, especially green or yellow in color
  • Poor weight gain
  • Distended abdomen
  • Gastro-esophageal reflux disease (GERD)