Pediatric Duodenal Atresia Workup

  • Author: Frederick Merrill Karrer, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Mar 5, 2012
 

Laboratory Studies

The following studies are indicated in duodenal atresia:

  • Serum electrolytes
    • Once delivered, neonates must be resuscitated well and electrolyte disturbances must be corrected prior to repair of duodenal atresia.
    • If duodenal atresia is diagnosed early, electrolyte and fluid balance should be normal. If the diagnosis is delayed at all, laboratory assessment of electrolyte and fluid status is imperative for an infant with duodenal atresia. As noted above, prolonged vomiting can result in a hypokalemic/hypochloremic metabolic alkalosis with paradoxical aciduria.
    • Obtain blood to measure serum electrolytes in order to confirm electrolyte status to prepare for adequate resuscitation.
  • Urinalysis
    • Urine specific gravity can serve as a reliable indicator of fluid status.
    • Fluid status can also be adequately assessed by urine output, capillary refill, mucous membrane examination, and fontanelle character.
  • Chromosome analysis: When trisomy 21 is suspected, a full genetic analysis should be performed; however, but this is not necessary to obtain prior to operative repair of the duodenal anomaly.
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Imaging Studies

  • Prenatal ultrasonography
    • Perform prenatal ultrasonography during any pregnancy with associated polyhydramnios. Examination of a fetus with duodenal atresia may reveal a dilated fluid-filled stomach and duodenum in addition to other (eg, cardiac) abnormalities. However, absence of these findings does not rule out duodenal obstruction.
    • Fetal vomiting may be associated with normal ultrasonographic findings in the presence of a duodenal atresia. Mothers with amniotic fluid abnormalities should be monitored with repeat scans.
    • Prenatal ultrasonography does not detect duodenal stenosis. Diagnosis prior to birth enables prenatal consultation with a pediatric surgeon and provides parents an opportunity to discuss plans for postnatal care and management.
  • Erect and recumbent plain radiography of the abdomen
    • When duodenal atresia is suspected, erect and recumbent plain radiography of the abdomen should be the first imaging study obtained.
    • A characteristic finding of duodenal obstruction is the double-bubble image of an air-filled stomach proximal to an air-filled first portion of the duodenum. Absence of gas in the remaining small and large bowel suggests atresia, whereas scattered amounts of gas distal to the obstruction suggests stenosis or malrotation/volvulus.
  • Cardiac and/or renal ultrasonography: Ultrasonography of the heart and kidneys may be warranted to identify potentially life-threatening abnormalities prior to definitive repair of the duodenal obstruction.
  • Upper GI contrast evaluation
    • Upper GI contrast evaluation in the infant with duodenal atresias is unnecessary unless correction is going to be delayed.
    • An upper GI contrast study may be useful if surgery is delayed to detect the presence of malrotation with midgut volvulus or to confirm the presence of an intrinsic duodenal obstruction.
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Histologic Findings

  • Histologic examination is rarely performed or necessary because repair does not involve removal of the obstruction.
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Contributor Information and Disclosures
Author

Frederick Merrill Karrer, MD  Professor of Surgery and Pediatrics, Head, Division of Pediatric Surgery, University of Colorado School of Medicine; The Dr David R and Kiku Akers Chair in Pediatric Surgery, Surgical Director, Pediatric Transplantation, The Children's Hospital

Frederick Merrill Karrer, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Study of Liver Diseases, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society of Transplant Surgeons, Children's Oncology Group, Colorado Medical Society, International Liver Transplantation Society, International Pediatric Transplant Association, International Society of Pediatric Surgical Oncology, Pacific Association of Pediatric Surgery, Society of Critical Care Medicine, Transplantation Society, and Western Surgical Association

Disclosure: Nothing to disclose.

Coauthor(s)

D Dean Potter, MD  Fellow in Pediatric Surgery, The Children's Hospital

D Dean Potter, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, International Pediatric Endosurgery Group, and Minnesota Medical Association

Disclosure: Nothing to disclose.

Casey M Calkins, MD  Assistant Professor of Surgery, Division of Pediatric Surgery, Department of Pediatric Surgery, Medical College of Wisconsin; Consulting Staff, Children's Hospital of Wisconsin

Casey M Calkins, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Pediatric Surgical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jayant Deodhar, MD  Associate Professor in Pediatrics, BJ Medical College, India; Honorary Consultant, Departments of Pediatrics and Neonatology, King Edward Memorial Hospital, India

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Piccoli, MD  Chief of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia; Professor, University of Pennsylvania School of Medicine

David A Piccoli, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, State University of New York Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References

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Complete duodenal obstruction.
Incomplete duodenal obstruction (duodenal stenosis).
Incision for duodenal exposure.
Side-to-side duodenoduodenostomy.
Diamond-shaped duodenoduodenostomy.
Upper GI contrast study following laparoscopic duodenal atresia repair. No leak is present, and an open anastomosis is shown. The white arrow highlights the anastomosis, which was performed using u-clips.
 
 
 
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