Duodenal Atresia


Risk

  • Incidence 1:5000–10,000 live births

  • Male to female incidence is equal

  • Trisomy 21 in 20–30%

  • 45% are premature infants of pregnancy complicated by polyhydramnios

  • Incidence of polyhydramnios 32–81%

  • Mortality 3–5%; due not to duodenal atresia but to associated CHD or prematurity

Perioperative Risks

  • Hypoxemia associated with immature lungs

  • Hypoxemia due to CHD, persistent fetal circulation (pulm Htn)

Worry About

  • Ventilation problems associated with prematurity.

  • Other associated anomalies in 50% of cases: esophageal atresia (7%), other intestinal atresias, renal anomalies (5%), malrotation of the gut (30%), volvulus, imperforate anus (3%), annular pancreas (25%).

  • CHD associated with trisomy 21 (ASD, VSD, AV canal).

  • Aspiration on induction of anesthesia secondary to bowel obstruction.

  • May be associated with cystic fibrosis.

  • Late presentation can be associated with dehydration, hypovolemia, and hypochloremic alkalosis.

Overview

  • Frequently premature infant of pregnancy complicated by polyhydramnios.

  • Polyhydramnios may occur in the absence of premature birth.

  • Diagnosis frequently made by prenatal ultrasound, allowing for parental counseling and planning for early repair; may not be detected until 28–32 wk gestation because of delay in development of proximal duodenal dilation.

  • Vomiting after birth: May be copious and bile stained. If obstruction is proximal to ampulla of Vater, emesis is nonbilious.

  • Flat abdomen.

  • Dx is made by “double bubble” on abdominal x-ray (dilated stomach and proximal duodenum).

  • Obstruction may be caused by partial obstruction: stenosis with perforated web or diaphragm rather than atresia; Dx may be delayed.

  • Coexisting distal intestinal atresia is rare (<1%).

Etiology

  • Unknown in sporadic cases

  • More common in trisomy 21

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