Pediatric Duodenal Atresia and Stenosis Surgery Workup

Updated: May 09, 2018
  • Author: Nicola Lewis, MBBS, FRCS, FRCS(Paed Surg); Chief Editor: Eugene S Kim, MD, FACS, FAAP  more...
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Workup

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 [21]
  • 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), [22] 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 present 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.

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. [23] 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. [24]

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