Duodenal atresia: Difference between revisions
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==Background== | ==Background== | ||
*During weeks 6 and 7 of gestation, the GI tract becomes occluded then recanalizes during weeks 8 to 10 | *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 | *Duodenal atresia is thought to result from failure of recanalization | ||
*Often associated with other malformations such as [[biliary atresia]] or gallbladder agenesis | *Often associated with other malformations such as [[Special:MyLanguage/biliary atresia|biliary atresia]] or gallbladder agenesis | ||
*May also be associated with cardiac, renal, or vertebral abnormalities | *May also be associated with cardiac, renal, or vertebral abnormalities | ||
*About a quarter of patients born with duodenal atresia have [[Down syndrome]] | *About a quarter of patients born with duodenal atresia have [[Special:MyLanguage/Down syndrome|Down syndrome]] | ||
==Clinical Features== | ==Clinical Features== | ||
''Presentation is very early in the postnatal period'' | ''Presentation is very early in the postnatal period'' | ||
*Abdominal distention and bilious [[vomiting|emesis]] within first 24 hours of birth | *Abdominal distention and bilious [[Special:MyLanguage/vomiting|emesis]] within first 24 hours of birth | ||
**Abdomen often markedly distended, with visible or palpable loops of bowel | **Abdomen often markedly distended, with visible or palpable loops of bowel | ||
**[[NG tube]] aspirate >20 mL | **[[Special:MyLanguage/NG tube|NG tube]] aspirate >20 mL | ||
*Signs of [[dehydration (peds)|dehydration]] (e.g. dry mucous membranes, poor skin turgor, and sunken fontanelle) | *Signs of [[Special:MyLanguage/dehydration (peds)|dehydration]] (e.g. dry mucous membranes, poor skin turgor, and sunken fontanelle) | ||
*+/- Signs of other congenital anomalies | *+/- Signs of other congenital anomalies | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Malrotation with [[volvulus (peds)|volvulus]] | |||
*[[Hirschsprung's disease]] | *Malrotation with [[Special:MyLanguage/volvulus (peds)|volvulus]] | ||
*Meconium [[ileus]] | *[[Special:MyLanguage/Hirschsprung's disease|Hirschsprung's disease]] | ||
*Meconium [[Special:MyLanguage/ileus|ileus]] | |||
*Other intestinal atresia | *Other intestinal atresia | ||
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{{N/v peds newborn}} | {{N/v peds newborn}} | ||
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==Evaluation== | ==Evaluation== | ||
[[File:DuodenalAtresiaXR.png|thumb|Double Bubble sign]] | [[File:DuodenalAtresiaXR.png|thumb|Double Bubble sign]] | ||
*Imaging | *Imaging | ||
**AP, lateral, and cross table [[KUB|XR]] should be obtained on all infants with concern for obstruction | **AP, lateral, and cross table [[Special:MyLanguage/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 | **Classic double bubble sign due to dilation of the stomach and proximal duodenum | ||
**Absent distal gas | **Absent distal gas | ||
==Management== | ==Management== | ||
*NPO | *NPO | ||
*[[NG tube]] to suction | *[[Special:MyLanguage/NG tube|NG tube]] to suction | ||
*Correct [[IVF|fluid]] and [[electrolyte abnormalities]] | *Correct [[Special:MyLanguage/IVF|fluid]] and [[Special:MyLanguage/electrolyte abnormalities|electrolyte abnormalities]] | ||
*[[Ampicillin]] and [[gentamicin]] (to prevent post-op infection) | *[[Special:MyLanguage/Ampicillin|Ampicillin]] and [[Special:MyLanguage/gentamicin|gentamicin]] (to prevent post-op infection) | ||
*Surgery | *Surgery | ||
==Disposition== | ==Disposition== | ||
*Admission | *Admission | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
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Latest revision as of 22:49, 4 January 2026
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 |
|
| Neurologic |
|
| Renal |
|
| Infectious | |
| Metabolic/endocrine | |
| Miscellaneous |
|
Evaluation
- 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