Radiograph with double-bubble sign from duodenal atresia
|Classification and external resources|
Duodenal atresia, also known as duodenojejunal atresia, is the congenital absence or complete closure of a portion of the lumen of the duodenum. It causes increased levels of amniotic fluid during pregnancy (polyhydramnios) and intestinal obstruction in newborn babies. Radiography shows a distended stomach and distended duodenum, which are separated by the pyloric valve, a finding described as the double-bubble sign.
Treatment includes suctioning out any fluid that is trapped in the stomach, providing fluids intravenously, and surgical repair of the intestinal closure.
Duodenal atresia occurs in 1 in every 5,000-10,000 live births.
History and physical examination
During pregnancy, duodenal atresia is associated with increased amniotic fluid in the uterus, which is called polyhydramnios. This increase in amniotic fluid is caused by the inability of the fetus to swallow the amniotic fluid and absorb it in their digestive tract.
After birth, duodenal atresia may cause abdominal distension, especially of the upper abdomen. Bilious vomiting commonly occurs within the first day of life. The vomiting is described as "bilious," because it contains bile acid.
The diagnosis of 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. The air is trapped in the stomach and proximal duodenum, which are separated by the pyloric sphincter, creating the appearance of two bubbles visible on x-ray. Since the closure of the duodenum is complete in duodenal atresia, no air is seen in the distal duodenum.
Atresias occurring distal to the duodenum are usually caused by vascular accidents or ischemic insult, such as jejunoileal atresia.
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. The surgery is not urgent. The initial repair has a 5 percent morbidity and mortality rate.
Prognosis is usually very good, although complications are more likely to occur when there are serious congenital anomalies. Late complications may occur in about 12 percent of patients with duodenal atresia, and the mortality rate for these complications is 6 percent.
- Kimura, Kim; Loening-Baucke, V (May 1, 2000). "Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction.". American family physician 61 (9): 2791–8. PMID 10821158. Retrieved 16 September 2012.
- "Duodenal Atresia". Retrieved 2007-12-03.
- Poki HO, Holland AJ, Pitkin J (2005). "Double bubble, double trouble". Pediatr. Surg. Int. 21 (6): 428–31. doi:10.1007/s00383-005-1448-z. PMID 15912365.
- Traubici J (August 2001). "The double bubble sign". Radiology 220 (2): 463–4. doi:10.1148/radiology.220.2.r01au11463. PMID 11477252.
- Spilde, Troy L; St Peter, SD; Keckler, SJ; Holcomb GW, 3rd; Snyder, CL; Ostlie, DJ (June 2008). "Open vs laparoscopic repair of congenital duodenal obstructions: a concurrent series.". Journal of pediatric surgery 43 (6): 1002–5. doi:10.1016/j.jpedsurg.2008.02.021. PMID 18558173. Retrieved 16 September 2012.
- Escobar, Mauricio A; Ladd, AP; Grosfeld, JL; West, KW; Rescorla, FJ; Scherer LR, 3rd; Engum, SA; Rouse, TM; Billmire, DF (June 2004). "Duodenal atresia and stenosis: long-term follow-up over 30 years.". Journal of pediatric surgery 39 (6): 867–71; discussion 867–71. doi:10.1016/j.jpedsurg.2004.02.025. PMID 15185215. Retrieved 16 September 2012.