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Pediatric Duodenal Atresia and Stenosis Surgery Workup

  • Author: Nicola Lewis, MBBS, FRCS, FRCS(Paed Surg); Chief Editor: Eugene S Kim, MD, FACS, FAAP  more...
 
Updated: Feb 08, 2016
 

Laboratory Studies

The following studies are commonly ordered:

  • 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 before general anesthesia and surgery
  • Karyotype analysis - Duodenal atresia is associated with trisomy 21 in 30% of cases[20]
  • 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
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Imaging Studies

Radiography

Plain abdominal radiography 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 the image below).

This is a radiograph of a 1-day-old infant presentThis is a radiograph of a 1-day-old infant presenting with duodenal atresia. Note the distended stomach and first part of the duodenum and the absence of air distal to the duodenal bubble.

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.[21] However, malrotation with volvulus is the leading diagnosis until proven otherwise. An upper gastrointestinal 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.

Ultrasonography

Echocardiography should be performed. Common cardiac defects include endocardial cushion defects and patent ductus arteriosus (PDA).

Abdominal/renal ultrasonography is useful in detecting renal anomalies and an annular pancreas.

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Biopsy

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

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Histologic Findings

Immunohistochemistry of proximal and distal duodenal samples of neonates with duodenal atresia demonstrated a decrease in the number and size of neuronal cells, decreased number of interstitial cells of Cajal, and hypertrophy of the circular muscles. These findings may help to explain persistent duodenal dysmotility seen in some patients long after their primary repair.[22]

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Contributor Information and Disclosures
Author

Nicola Lewis, MBBS, FRCS, FRCS(Paed Surg) Consultant Paediatric Surgeon, Department of Surgery, Scarborough General Hospital

Nicola Lewis, MBBS, FRCS, FRCS(Paed Surg) is a member of the following medical societies: Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Coauthor(s)

Philip Glick, MD, MBA Professor, Departments of Surgery, Pediatrics, and Gynecology and Obstetrics, Vice-Chairperson for Finance 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, Society of University Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Andre Hebra, MD Chief, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, Medical University of South Carolina College of Medicine; Surgeon-in-Chief, Medical University of South Carolina Children's Hospital

Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, Florida Medical Association, Society of American Gastrointestinal and Endoscopic Surgeons, Children's Oncology Group, International Pediatric Endosurgery Group, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Eugene S Kim, MD, FACS, FAAP Associate Professor of Surgery, Division of Pediatric Surgery, Keck School of Medicine of the University of Southern California; Attending Pediatric Surgeon, Children's Hospital Los Angeles

Eugene S Kim, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, Society of University Surgeons, Texas Medical Association, Children's Oncology Group

Disclosure: Nothing to disclose.

Additional Contributors

Robert K Minkes, MD, PhD Professor of Surgery, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Medical Director and Chief of Surgical Services, Children's Medical Center of Dallas-Legacy Campus

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, Phi Beta Kappa

Disclosure: Nothing to disclose.

References
  1. Fonkalsrud EW, DeLorimier AA, Hays DM. Congenital atresia and stenosis of the duodenum. A review compiled from the members of the Surgical Section of the American Academy of Pediatrics. Pediatrics. 1969 Jan. 43(1):79-83. [Medline].

  2. Bailey PV, Tracy TF Jr, Connors RH, et al. Congenital duodenal obstruction: a 32-year review. J Pediatr Surg. 1993 Jan. 28(1):92-5. [Medline].

  3. Mooney D, Lewis JE, Connors RH, Weber TR. Newborn duodenal atresia: an improving outlook. Am J Surg. 1987 Apr. 153(4):347-9. [Medline].

  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. 1990 Sep. 25(9):977-9. [Medline].

  5. Reid IS. Biliary tract abnormalities associated with duodenal atresia. Arch Dis Child. 1973 Dec. 48(12):952-7. [Medline].

  6. Stringer MD, Brereton RJ, Drake DP, Wright VM. Double duodenal atresia/stenosis: a report of four cases. J Pediatr Surg. 1992 May. 27(5):576-80. [Medline].

  7. Boyden EA, Cope JG, Bill AH Jr. Anatomy and embryology of congenital intrinsic obstruction of the duodenum. Am J Surg. 1967 Aug. 114(2):190-202. [Medline].

  8. Mishalany HG, Der Kaloustian VM, Ghandour MH. Familial congenital duodenal atresia. Pediatrics. 1971 Mar. 47(3):633-4. [Medline].

  9. Kokkonen ML, Kalima T, Jaaskelainen J, Louhimo I. Duodenal atresia: late follow-up. J Pediatr Surg. 1988 Mar. 23(3):216-20. [Medline].

  10. Escobar MA, Ladd AP, Grosfeld JL, et al. Duodenal atresia and stenosis: long-term follow-up over 30 years. J Pediatr Surg. 2004 Jun. 39(6):867-71; discussion 867-71. [Medline].

  11. 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. 1993 May-Jun. 17(3):301-9. [Medline].

  12. Harberg FJ, Pokorny WJ, Hahn H. Congenital duodenal obstruction. A review of 65 cases. Am J Surg. 1979 Dec. 138(6):825-8. [Medline].

  13. Kimble RM, Harding J, Kolbe A. Additional congenital anomalies in babies with gut atresia or stenosis: when to investigate, and which investigation. Pediatr Surg Int. 1997. 12(8):565-70. [Medline].

  14. Spitz L, Ali M, Brereton RJ. Combined esophageal and duodenal atresia: experience of 18 patients. J Pediatr Surg. 1981 Feb. 16(1):4-7. [Medline].

  15. Hancock BJ, Wiseman NE. Congenital duodenal obstruction: the impact of an antenatal diagnosis. J Pediatr Surg. 1989 Oct. 24(10):1027-31. [Medline].

  16. Feingold M, Hall BD, Lacassie Y, Martínez-Frías ML. Syndrome of microcephaly, facial and hand abnormalities, tracheoesophageal fistula, duodenal atresia, and developmental delay. Am J Med Genet. 1997 Mar 31. 69(3):245-9. [Medline].

  17. Phelps S, Fisher R, Partington A, et al. Prenatal ultrasound diagnosis of gastrointestinal malformations. J Pediatr Surg. 1997 Mar. 32(3):438-40. [Medline].

  18. al-Salem AH, Khwaja S, Grant C, Dawodu A. Congenital intrinsic duodenal obstruction: problems in the diagnosis and management. J Pediatr Surg. 1989 Dec. 24(12):1247-9. [Medline].

  19. Britton JR, Britton HL. Gastric aspirate volume at birth as an indicator of congenital intestinal obstruction. Acta Paediatr. 1995 Aug. 84(8):945-6. [Medline].

  20. Keckler SJ, St Peter SD, Spilde TL, Ostlie DJ, Snyder CL. The influence of trisomy 21 on the incidence and severity of congenital heart defects in patients with duodenal atresia. Pediatr Surg Int. 2008 Aug. 24(8):921-3. [Medline].

  21. Tashjian DB, Moriarty KP. Duodenal atresia with an anomalous common bile duct masquerading as a midgut volvulus. J Pediatr Surg. 2001 Jun. 36(6):956-7. [Medline].

  22. Alatas FS, Masumoto K, Esumi G, Nagata K, Taguchi T. Significance of abnormalities in systems proximal and distal to the obstructed site of duodenal atresia. J Pediatr Gastroenterol Nutr. 2012 Feb. 54(2):242-7. [Medline].

  23. Berger D, Roulet M. Early postoperative enteral feeding through a needle catheter jejunostomy. Z Kinderchir. 1984 Oct. 39(5):328-31. [Medline].

  24. Upadhyay V, Sakalkale R, Parashar K, Mitra SK, Buick RG, Gornall P, et al. Duodenal atresia: a comparison of three modes of treatment. Eur J Pediatr Surg. 1996 Apr. 6(2):75-7. [Medline].

  25. Soutter AD, Askew AA. Transumbilical laparotomy in infants: a novel approach for a wide variety of surgical disease. J Pediatr Surg. 2003 Jun. 38 (6):950-2. [Medline].

  26. Ein SH, Kim PC, Miller HA. The late nonfunctioning duodenal atresia repair--a second look. J Pediatr Surg. 2000 May. 35(5):690-1. [Medline].

  27. Spilde TL, St Peter SD, Keckler SJ, Holcomb GW 3rd, Snyder CL, Ostlie DJ. Open vs laparoscopic repair of congenital duodenal obstructions: a concurrent series. J Pediatr Surg. 2008 Jun. 43(6):1002-5. [Medline].

  28. Kay S, Yoder S, Rothenberg S. Laparoscopic duodenoduodenostomy in the neonate. J Pediatr Surg. 2009 May. 44(5):906-8. [Medline].

  29. Parmentier B, Peycelon M, Muller CO, El Ghoneimi A, Bonnard A. Laparoscopic management of congenital duodenal atresia or stenosis: A single-center early experience. J Pediatr Surg. 2015 Nov. 50 (11):1833-6. [Medline].

  30. Bishay M, Lakshminarayanan B, Arnaud A, et al. The role of parenteral nutrition following surgery for duodenal atresia or stenosis. Pediatr Surg Int. 2013 Feb. 29(2):191-5. [Medline].

  31. Spigland N, Yazbeck S. Complications associated with surgical treatment of congenital intrinsic duodenal obstruction. J Pediatr Surg. 1990 Nov. 25(11):1127-30. [Medline].

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Three anatomic types of duodenal atresia are recognized. In type 1 atresia, a membrane traverses the internal diameter of the duodenum. This membrane may be elongated, giving rise to the windsock type 1 duodenal atresia. In type 2 atresia, the atretic ends of the duodenum are connected by a fibrous cord. In type 3 atresia, the atretic segments are completely separated.
This is a radiograph of a 1-day-old infant presenting with duodenal atresia. Note the distended stomach and first part of the duodenum and the absence of air distal to the duodenal bubble.
During the diamond-shaped anastomosis, a proximal transverse to distal longitudinal anastomosis is performed; the midpoint of the proximal incision is approximated to the end of the distal incision.
 
 
 
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