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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

Imaging Studies


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.


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.



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


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]

Contributor Information and Disclosures

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.


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.

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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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