duodenal atresia

Duodenal atresia

Introduction • congenital duodenal atresia is one of the more common

intestinal anomalies treated by pediatric surgeons,

occurring 1 in 2500-5000 live births. In 25-40% of

cases, the anomaly is encountered in an infant with

trisomy 21 (Down syndrome).The definitive

intervention to correct the anomaly is surgical and

consists of duodenoduodenostomy in the newborn

period.

Definition• Duodenal atresia is a condition in which the first

part of the small bowel (the duodenum) 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 to result from problems during an embryo's

development in which the duodenum does not

normally change from a solid to a tube-like structure.

Cont…

• Duodenal atresia is seen in more than 1 in 2500-

5000 live births. Approximately 25 -40% of

infants with duodenal atresia have Down

syndrome. Duodenal atresia is often associated

with other birth defects.

Symptoms• Upper abdominal swelling may or may not be present

• Early vomiting of large amounts, which may be greenish

(containing bile)

• Continued vomiting even when infant has not been fed

for several hours

• Absent urination after first few voiding

• Absent bowel movements after first few meconium

stools

Diagnostic Evaluation

• fetal ultrasound

• Abdominal x-ray

Treatment• Medical Therapy

– No medical therapies are available for the definitive

treatment of duodenal atresia or stenosis; all treatment

is surgical. Adequate intravenous (IV) hydration, total

parenteral nutrition, and gastric decompression are

essential until the neonate has been stabilized for

surgical repair.

Surgical Therapy

• Duodenal atresia and stenosis are treated surgically. In

patients with duodenal obstruction, a

duodenoduodenostomy is the most commonly performed

procedure.

• A duodenojejunostomy is now uncommonly performed due

to its higher risk of long-term complications. Duodenal repair

may be performed via a right upper quadrant incision, an

umbilical incision, or laparoscopically, depending on surgeon

preference.

Complications– Other birth defects

– Dehydration

After surgery, there may be late complications such as:

– Swelling of the first part of the small bowel

(megaduodenum)

– Problems with movement through the intestines

– Gastro esophageal reflux

Bibliography• Marlow, text book of pediatric nursing, 6th edition , Saunders an imprint of Elsevier ,

page no.-

• Wong’s, essential of pediatric nursing, 8th edition, Elsevier sector-16 Nodia, page no.

– 825-833.

• Parul data, pediatric Nursing, 2nd edition, jaypee brother medical publisher(P) ltd.

Mew delhi, page no.-

• http://columbusfetalmedicine.org/services-duodenal-atresia.cfm

• http://childrens.memorialhermann.org/texas-fetal-center/duodenal-atresia-repair/

• http://www.ajronline.org/content/192/5/1269.full

• http://www.nlm.nih.gov/medlineplus/ency/presentations/100165_3.htm