Duodenal Atresia
INTRODUCTION:
Present a failure of recanalisation of the bowel lumen that is a solid tube early in fetal life (~11-12 weeks).
During pregnancy, duodenal atresia is associated with increased amniotic fluid in the uterus, which is called polyhydramnios.
After birth, duodenal atresia may cause abdominal distension, especially of the upper abdomen.
Duodenal atresia (DA) occur as a result of failure of vacuolization of the duodenum from its solid cord stage.
Bilious vomiting commonly occurs within the first day of life.
Clinical features
Duodenal stenosis causing constipation, mucosal web with intact muscular wall (so-called windsock deformity).
Two ends separated by a fibrous cord, or complete separation with a gap within the duodenum.
The duodenal obstruction is distal to the ampulla of Vater, and infants present with bilious emesis in the neonatal period. In patients with a mucosal web.
ASSOCIATED ANOMALIES
Prematurity
Down syndrome
Maternal polyhydramnios
Annular pancreas
Biliary atresia.
Other anomalies, such as cardiac, renal, esophageal, and anorectal anomalies, are also common.
DIAGNOSIS
Duodenal atresia is usually confirmed by radiography.
An X-ray of the abdomen shows two large air filled spaces, the so-called “double bubble” sign.
Appearance of two bubbles visible on x-ray.
TREATMENT
Early treatment includes removing fluids from the stomach via a nasogastric tube, and providing fluids intravenously.
The definitive treatment for duodenal atresia is surgery (duodenoduodenostomy), which may be performed openly or laparoscopically