intestinal atresia

Duodenal atresiaDuodenal atresia 1:6000-1:100001:6000-1:10000 Common site of neonatal Common site of neonatal

intestinal obstructionintestinal obstruction Survival ~95%Survival ~95% Associated anomalies- 50%Associated anomalies- 50% Down’s synd- 30%Down’s synd- 30%

WWW.SMSO.CCWWW.SMSO.CC

Embryology Embryology 44thth week- gut forms week- gut forms 66thth week- proliferation of gut week- proliferation of gut

epithelium -epithelium - obstruction of obstruction of lumenlumen

Recanalization failure Recanalization failure duodenal duodenal atresiaatresia


Types Types Complete 80%, incomplete 20%Complete 80%, incomplete 20% Gray & SkandalakisGray & Skandalakis

– Ty1 - web/ septum- 90%, no Ty1 - web/ septum- 90%, no muscle/ mesenteric defectmuscle/ mesenteric defect

– Ty 2 – cord connects two blind ends-Ty 2 – cord connects two blind ends-2%, no mesenteric defect2%, no mesenteric defect

– Ty 3- v shaped mesenteric defectTy 3- v shaped mesenteric defect



Clinical featuresClinical features Antenatal diag-Antenatal diag-

– “ “double bubble”double bubble”– polyhydramnios polyhydramnios

Post natal- Post natal- – bilious vomitingbilious vomiting– Upper abd fullnessUpper abd fullness– Aspirate> 30 ml , biliousAspirate> 30 ml , bilious


Investigation Investigation X Ray Abd-X Ray Abd-

– double bubble double bubble – +/- distal gas+/- distal gas

Evaluate for Down’s syndEvaluate for Down’s synd


Management Management NOT a surgical emergencyNOT a surgical emergency NG/OG aspirationNG/OG aspiration IV fluidIV fluid Temperature controlTemperature control TPNTPN


Surgery- Kimura’s Surgery- Kimura’s duodenoduodenostomduodenoduodenostomy y





Complication Complication Leak/ obstructionLeak/ obstruction Feed intoleranceFeed intolerance


Intestinal atresiaIntestinal atresia


Jejunoileal atresiaJejunoileal atresia Atresia- obstruction due to Atresia- obstruction due to

complete occlusion of lumen, 95%complete occlusion of lumen, 95% Stenosis- partial intestinal Stenosis- partial intestinal

obstruction due to subtotal obstruction due to subtotal occlusion of lumen, 5%occlusion of lumen, 5%

Maternal use of psuedoephedrine, Maternal use of psuedoephedrine, ergot,caffeineergot,caffeine


Embryology Embryology Mesenteric Vascular accidentsMesenteric Vascular accidents Late pregnancyLate pregnancy volvulus, gastroschisis, volvulus, gastroschisis,

omphalocele, internal herniasomphalocele, internal hernias Louw & Bernard experimentsLouw & Bernard experiments


Clinical featuresClinical features

antenatal USG- poor predictive antenatal USG- poor predictive valuevalue


Examination Examination DistentionDistention Dilated veinsDilated veins Visible bowel loopsVisible bowel loops Visible peristalsisVisible peristalsis Signs appear 12-24 hr after birthSigns appear 12-24 hr after birth


Investigation Investigation

X ray abd- erect/ supineX ray abd- erect/ supine– Dilated bowel loopsDilated bowel loops– AF levelsAF levels– Paucity of gas beyond obstructionPaucity of gas beyond obstruction– Abd calcification/ intraluminal Abd calcification/ intraluminal

calcificationcalcificationWWW.SMSO.CCWWW.SMSO.CC

Differential diagnosisDifferential diagnosis Meconium ileusMeconium ileus TCATCA Internal herniaInternal hernia Malrotation Malrotation Colonic atresiaColonic atresia Duplication Duplication Sepsis Sepsis


Distribution Distribution Jejunum: ileum-50% eachJejunum: ileum-50% each MC- distal ileumMC- distal ileum 90% single, 6- 20% multiple90% single, 6- 20% multiple





Management Management NPONPO NG/OG suctionNG/OG suction IV fluidsIV fluids Temp controlTemp control Vit KVit K Antibiotics Antibiotics



Surgical optionsSurgical options Excision of grossly dilated prox bowel Excision of grossly dilated prox bowel

with end- oblique anastomosiswith end- oblique anastomosis Tapering jejunoplasty with Tapering jejunoplasty with

anastomosisanastomosis Preserve bowel lengthPreserve bowel length Other associated anomalies correctionOther associated anomalies correction Resection with exteriorization- poor Resection with exteriorization- poor

vascularity/ contaminationvascularity/ contaminationWWW.SMSO.CCWWW.SMSO.CC



Complications Complications LeakLeak ObstructionObstruction Sepsis/ peritonitis/pneumoniaSepsis/ peritonitis/pneumonia







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intestinal atresia

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