What is duodenal atresia?
The duodenum is the first part of the small intestine. It is located between the stomach and the rest of the small intestine. When the duodenum is blocked and doesn’t allow food to move from the stomach into the rest of the intestine, your baby will be diagnosed with duodenal atresia. The condition is the result of the duodenum not developing properly.
The cause of this condition is unknown. Duodenal atresia occurs in one out of every 2,500 live births. Half of the infants with this condition are born prematurely and approximately two-thirds have associated abnormalities of the heart, genitourinary or intestinal tract. Nearly 40 percent have Down Syndrome.
How is the condition diagnosed?
The condition is often diagnosed by ultrasound during pregnancy. During an ultrasound, your doctor might suspect duodenal atresia if the fetal stomach is enlarged or abnormally shaped and there is too much amniotic fluid (the fluid that surrounds your fetus in the womb). If there is fluid in the baby’s stomach and in part of the duodenum, but no fluid beyond that, this is known as the “double-bubble sign.” If there is too much amniotic fluid in the womb, this condition is known as polyhydramnios. This condition is not usually diagnosed until the second half of pregnancy and may not be seen until you are in the third trimester. If there is polyhydramnios, there is an increased risk for preterm labor, and our team will do additional testing and monitor you for this.
How is duodenal atresia treated?
Duodenal atresia cannot be treated before the baby is born. If it’s diagnosed during an ultrasound, your doctor will monitor your pregnancy very carefully with additional ultrasounds. Your baby’s heart, genitourinary system and intestinal tract will be examined closely for additional abnormalities. You will meet with our genetic counselor to discuss additional testing to determine if there are chromosomal abnormalities. We may discuss performing and amniocentesis to test for Down Syndrome. If there is too much amniotic fluid and you have signs of preterm labor or difficulty breathing, we may recommend an amnioreduction procedure. Our nurse navigator will arrange for you to meet with neonatologists and pediatric surgeons to discuss the care your baby may need after birth. After the baby is born, he or she will be cared for in our newborn intensive care unit (NICU) to undergo further evaluation and treatment. You may wish to tour the NICU prior to your baby’s birth.
How will duodenal atresia affect my baby during and after surgery?
Soon after birth, excess intestinal contents and gas that contribute to abdominal swelling (distention) is removed through a tube that is placed into the stomach through the mouth or nose. Your baby will not be able to eat anything by mouth, and additional testing will be done to determine exactly where the obstruction lies.
Surgery is usually done within one to two days after birth. Duodenal atresia is repaired by connecting the blocked segment of duodenum to the portion of duodenum just beyond the obstruction.
A nasogastric (NG) tube is left in place to allow air and fluid to escape until your baby’s bowel function returns. This may vary from a few days to several weeks. During the period of bowel inactivity, nutrition is provided intravenously. Once the intestinal function is normalized, nutrition is provided orally or through a feeding tube.
Your baby will need to stay in the NICU for several weeks after surgery, until he/she is eating well and showing adequate weight gain.
Children who undergo surgery for intestinal atresia require regular follow-up to ensure adequate growth and development, and to avoid nutritional deficiencies that may occur as a result of the loss of intestine. How babies progress depends to a large extent on whether there is an associated abnormality and whether the baby is left with an adequate length of intestine. You will be closely followed by our team of specialists as your baby continues to grow.