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Stomach and small intestine
Stomach and small intestine

Duodenal atresia
Definition:
Duodenal atresia is a condition in which the duodenum (the first part of the small bowel) has not developed properly. It is not open and cannot allow the passage of stomach contents.

Causes, incidence, and risk factors:

The cause of duodenal atresia is unknown but it is thought that damage to the duodenum from a loss of blood supply during gestation causes the duodenum to narrow and become obstructed.

Duodenal atresia is present in approximately 1 out of 6,000 newborns. There is an increased association of duodenal atresia with Downs syndrome. Approximately 25% of duodenal atresia is found in infants with Downs.

Infants born with duodenal atresia begin vomiting large amounts of material shortly after birth. The vomitus may be green (bile stained) and the volume often is greater than that which is fed to the infant. One or two initial meconium stools may be passed but no others. Untreated, these infants dehydrate and become critically ill very rapidly.

Suggestion of duodenal atresia may be seen on routine ultrasound studies of the fetus. Suspected atresia may be diagnosed after birth with an X-ray. Surgery to fix the duodenum is then performed. Following surgery, infants may have significant feeding and absorption problems.

Symptoms:
  • abnormal fetal ultrasound
  • early vomiting of large amounts
  • green vomiting (bile)
  • continued vomiting even when infant has not been fed for several hours
  • absent urination after first few voidings
  • absent bowel movements after first few meconium stools
Signs and tests:
Other signs:
  • excessive amniotic fluid (polyhydramnios)
  • Downs syndrome is present in a quarter of cases of duodenal atresia
Treatment:
Surgery to remove the blocked section of duodenum is necessary. The patient receives a general anesthetic. An incision is made in the abdomen. The abnormal segment of duodenum is removed, and the remaining ends of the bowel are reconnected. Associated problems (such as Downs syndrome) must be treated as appropriate.
Expectations (prognosis):
Recovery from the duodenal atresia is expected after treatment. There may be persistent feeding problems, absorption problems, and increased vitamin requirements (vitamin B12) following surgery, but this is unusual. Untreated, the condition is fatal.
Complications:
Calling your health care provider:
Call your health care provider if your newborn is feeding poorly or not at all, vomiting (not spitting), not urinating or stooling, or if the vomitus is green.
Review Date: 3/3/2002
Reviewed By: Robert W. O'Rourke, M.D., Department of Minimally Invasive Surgery, Legacy Health System, Portland, OR. Review provided by VeriMed Healthcare Network.
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