Download - 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