Duodenal Atresia

Duodenal atresia

Complete obstruction

3 types

Type I

more than 90% of duodenum

Contain a luminal diaphragm (windsock)

Type II

Dilated proximal and collapsed distal

Connected by fibrous cord

Type III

Obvious gap separating proximal and distal part

Incidence

1 per 5000 to 10,000 live births

Male > Female

50% associated with congenital anomaly, 30% associated with trisomy 21

Etiology

Failure of recanalization of the fetal duodenum (GA 11th)

Pathology

85% postampullary

Stomach and proximal duodenal become dilated

Pylorus is distended and hypertrophic

Distal bowel is collapsed (except windsock)

Diagnosis

Prenatal ultrasonography : polyhydramnios, double bubble sign

Two fluid-filled structure

Diagnosis

Presentation

Bilious emesis within the first hour of life (except preampullary)

Intolerance of feeding

Failure to pass meconium in 24 hr

Scaphoid abdomen

Maybe abdominal distension (epigastrium)

Aspiration via NG tube > 20 ml

Diagnosis

Radiography : plain film upright abdomen Double bubble sign with no distal bowel gas

Proximal left-side with air and fluid filled stomach

Right of midline dilated proximal duodenum

Distal bowel is gasless

Management

Resuscitate, correct electrolyte imbalance and decompression

Lab : CBC, electrolyte, coagulogram, abdominal and spinal ultrasound evaluation, two-dimensional echocardiography

Surgery ( emergency when cannot exclude malrotation or volvulus) : duodenoduodenostomy

Side to side

Diamond shape : proximal transverse to distal longitudinal

Diamond shape

Side to side

Complication

Early complication

Anastomisis leak

Duodenal ileus

Stenosis

Perforation

Complication

Long-term complication

Blind loop syndrome duodenoduodenostomy

Megaduodenum with abnormal duodenal motility tapering duodenoplasty or plication

Duodenogastric reflux

Gastritis

Peptic ulceration

Tapering duodenoplasty

Complication

Long-term complication (cont.)

Gastroesophageal reflux

Esophagitis

Pancreatitis

Cholecystitis

Cholelithiasis