Duodenal atresia: Difference between revisions

Latest revision as of 16:30, 28 October 2019

Background

During weeks 6 and 7 of gestation, the GI tract becomes occluded then recanalizes during weeks 8 to 10
Duodenal atresia is thought to result from failure of recanalization
Often associated with other malformations such as biliary atresia or gallbladder agenesis
May also be associated with cardiac, renal, or vertebral abnormalities
About a quarter of patients born with duodenal atresia have Down syndrome

Clinical Features

Presentation is very early in the postnatal period

Abdominal distention and bilious emesis within first 24 hours of birth
- Abdomen often markedly distended, with visible or palpable loops of bowel
- NG tube aspirate >20 mL
Signs of dehydration (e.g. dry mucous membranes, poor skin turgor, and sunken fontanelle)
+/- Signs of other congenital anomalies

Differential Diagnosis

Malrotation with volvulus
Hirschsprung's disease
Meconium ileus
Other intestinal atresia

Nausea and vomiting (newborn)

Newborn	'
Obstructive intestinal anomalies	Esophageal stenosis/atresia Pyloric stenosis Intestinal stenosis/atresia Duodenal atresia Malrotation ± volvulus Incarcerated hernia Meconium ileus/plug Hirschsprung's disease Imperforate anus Enteric duplications
Neurologic	Intracranial bleed/mass Hydrocephalus Cerebral edema Kernicterus
Renal	Urinary tract infection Obstructive uropathy Renal insufficiency
Infectious	Viral illness Acute gastroenteritis Meningitis Sepsis
Metabolic/endocrine	Inborn errors of metabolism Adrenal insufficiency Congenital adrenal hyperplasia
Miscellaneous	Ileus Gastroesophageal reflux disease Necrotizing enterocolitis Milk allergy, FPIES GI perforation

Evaluation

Double Bubble sign

Imaging
- AP, lateral, and cross table XR should be obtained on all infants with concern for obstruction
- Classic double bubble sign due to dilation of the stomach and proximal duodenum
- Absent distal gas

Management

NPO
NG tube to suction
Correct fluid and electrolyte abnormalities
Ampicillin and gentamicin (to prevent post-op infection)
Surgery

Disposition

Admission

References

Authors:

@@ Line 2: / Line 2: @@
 *During weeks 6 and 7 of gestation, the GI tract becomes occluded then recanalizes during weeks 8 to 10
 *Duodenal atresia is thought to result from failure of recanalization
+*Often associated with other malformations such as [[biliary atresia]] or gallbladder agenesis
+*May also be associated with cardiac, renal, or vertebral abnormalities
+*About a quarter of patients born with duodenal atresia have [[Down syndrome]]
 ==Clinical Features==
-*Often presents with gastric distension and vomiting
+''Presentation is very early in the postnatal period''
-*Often associated with other malformations such as biliary atresia or gallbladder agenesis
+*Abdominal distention and bilious [[vomiting|emesis]] within first 24 hours of birth
-*May also be associated with cardiac, renal, or vertebral abnormalities
+**Abdomen often markedly distended, with visible or palpable loops of bowel
-*About a quarter of patients born with duodenal atresia have Downs syndrome
+**[[NG tube]] aspirate >20 mL
+*Signs of [[dehydration (peds)|dehydration]] (e.g. dry mucous membranes, poor skin turgor, and sunken fontanelle)
+*+/- Signs of other congenital anomalies
 ==Differential Diagnosis==
-*Malrotation with volvulus
+*Malrotation with [[volvulus (peds)|volvulus]]
-*Hirschsprung disease
+*[[Hirschsprung's disease]]
-*Meconium ileus
+*Meconium [[ileus]]
-*Intestinal atresia
+*Other intestinal atresia
 {{N/v peds newborn}}
-==Diagnosis==
+==Evaluation==
-*Presentation is very early in the postnatal period
+[[File:DuodenalAtresiaXR.png|thumb|Double Bubble sign]]
-*History
-**Often includes history of abdominal distention and vomiting
-**Obtain hx of whether vomiting is bilious or nonbilious and if vomiting follows feeds
-*Physical Exam
-**Dry mucus membranes, poor skin turgor, and sunken fontanelle
-**Document signs of other congenital anomalies
-**The abdomen is often markedly distended with visible or palpable loops of bowel.
-**Examine perineum and assess for patency of the anus
-==Management==
 *Imaging
-**AP, lateral, and cross table XR should be obtained on all infants with concern for obstruction
+**AP, lateral, and cross table [[KUB|XR]] should be obtained on all infants with concern for obstruction
 **Classic double bubble sign due to dilation of the stomach and proximal duodenum
 **Absent distal gas
-*Treatment
+==Management==
-**NPO
+*NPO
-**NG tube to suction
+*[[NG tube]] to suction
-**Correct fluid and electrolyte abnormalities
+*Correct [[IVF|fluid]] and [[electrolyte abnormalities]]
-**Ampicillin and gentamicin (to prevent post-op infection)
+*[[Ampicillin]] and [[gentamicin]] (to prevent post-op infection)
-**Surgery
+*Surgery
 ==Disposition==
@@ Line 47: / Line 40: @@
 ==References==
-<UpToDate>
+<references/>
+[[Category:GI]]
+[[Category:Pediatrics]]
+[[Category:Surgery]]