eMedicine Specialties > Pediatrics: Surgery > General Surgery

Duodenal Atresia and Stenosis: Surgical Perspective: Workup

Author: Nicola Lewis, MBBS, FRCS, Specialist Registrar, Department of Surgery, Birmingham Children's Hospital, UK
Coauthor(s): Philip Glick, MD, MBA, Professor, Departments of Surgery, Pediatrics, and Gynecology and Obstetrics, Vice-Chairperson for Research and Development, Department of Surgery, State University of New York at Buffalo
Contributor Information and Disclosures

Updated: Oct 1, 2008

Workup

Laboratory Studies

  • Serum electrolytes: Infants with duodenal atresia have large gastric aspirates. Consequently, duodenal atresia is associated with loss of fluid and electrolytes secreted by the stomach and, in 85% of cases, pancreatic and biliary fluid.
  • Hematocrit: The hematocrit gives an indication of the oxygen-carrying capacity of the neonate prior to general anesthesia and surgery.
  • Karyotype analysis: Duodenal atresia is associated with trisomy 21 in 30% of cases.18
  • Blood glucose: Duodenal atresia is associated with premature onset of labor. The premature infant has limited glycogen supplies and is more likely to become hypoglycemic.
  • Blood type and cross-match

Imaging Studies

  • Plain abdominal radiography
    • This study usually reveals a dilated stomach, a dilated first part of duodenum (double bubble), and absence of air beyond the second air bubble.
    • Aspiration of the stomach contents followed by gentle air insufflation makes the double-bubble sign more apparent (see Media file 2).
  • Upper GI contrast study
    • If a scattered small amount of air is observed distal to the obstruction, duodenal stenosis may be present or other causes of partial intestinal obstruction may exist. Occasionally, air may be seen distally when duodenal atresia is associated with a biliary communication between proximal and distal segments.19 However, malrotation with volvulus is the leading diagnosis until proven otherwise.
    • An upper GI contrast study should be performed. This is useful in making the diagnosis of duodenal stenosis, malrotation or volvulus, annular pancreas, duodenal duplications, and duodenal webs.
  • Echocardiography
  • Abdominal/renal ultrasonography: This study is useful in detecting renal anomalies and an annular pancreas.

Diagnostic Procedures

  • Rectal biopsy: Biopsy findings exclude Hirschsprung disease in patients with intrinsic duodenal obstruction and Down syndrome.

More on Duodenal Atresia and Stenosis: Surgical Perspective

Overview: Duodenal Atresia and Stenosis: Surgical Perspective
Workup: Duodenal Atresia and Stenosis: Surgical Perspective
Treatment: Duodenal Atresia and Stenosis: Surgical Perspective
Follow-up: Duodenal Atresia and Stenosis: Surgical Perspective
Multimedia: Duodenal Atresia and Stenosis: Surgical Perspective
References
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References

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  4. Kimura K, Mukohara N, Nishijima E, et al. Diamond-shaped anastomosis for duodenal atresia: an experience with 44 patients over 15 years. J Pediatr Surg. Sep 1990;25(9):977-9. [Medline].

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  7. Grosfeld JL, Rescorla FJ. Duodenal atresia and stenosis: reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long-term follow-up. World J Surg. May-Jun 1993;17(3):301-9. [Medline].

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Further Reading

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Keywords

duodenal atresia, stenosis, congenital duodenal obstruction, gastrojejunostomy, duodenojejunostomy, duodenoduodenostomy, duodenoplasty, intrinsic duodenal obstruction, high intestinal obstruction, upper intestinal obstruction, sustained vomiting, bilious vomiting, nonbilious vomiting, loss of fluid, loss of electrolytes, hyperalimentation, Down syndrome, esophageal atresia, malrotation, anterior portal vein, second distal web, anorectal anomalies, intestinal atresias, cloacal anomalies, renal tract anomalies, polyhydramnios, choledochal cyst, failure to thrive

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Contributor Information and Disclosures

Author

Nicola Lewis, MBBS, FRCS, Specialist Registrar, Department of Surgery, Birmingham Children's Hospital, UK
Disclosure: Nothing to disclose.

Coauthor(s)

Philip Glick, MD, MBA, Professor, Departments of Surgery, Pediatrics, and Gynecology and Obstetrics, Vice-Chairperson for Research and Development, Department of Surgery, State University of New York at Buffalo
Philip Glick, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, Central Surgical Association, Federation of American Societies for Experimental Biology, Medical Society of the State of New York, Phi Beta Kappa, Physicians for Social Responsibility, Royal College of Surgeons of England, Sigma Xi, Society for Pediatric Research, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, and Society of University Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Robert K Minkes, MD, PhD, Professor of Surgery, University of Texas Southwestern; Chief of Surgical Services, Children's Medical Center of Dallas-Legacy
Robert K Minkes, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

H Biemann Othersen Jr, MD, Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina
H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Marleta Reynolds, MD, Professor of Surgery, Feinberg School of Medicine, Northwestern University; Interim Head, Division of Pediatric Surgery, Department of Surgery, Children's Memorial Hospital of Chicago
Marleta Reynolds, MD is a member of the following medical societies: American Pediatric Surgical Association
Disclosure: Nothing to disclose.

 
 
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