Pediatric Duodenal Atresia Workup

Updated: Aug 09, 2016
  • Author: Frederick Merrill Karrer, MD, FACS; Chief Editor: Carmen Cuffari, MD  more...
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Workup

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

The imaging studies used in this condition are as follows:

  • 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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