Duodenal atresia

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 What is duodenal atresia?

Duodenal atresia is a rare condition some babies are born with that causes blockage of the bowel.

Duodenal atresia is where the opening in the duodenum (the tube that connects the stomach to the bowels) is too narrow or closed so food cannot pass into the intestines.

All babies with duodenal atresia will need surgery.

Around 1 in 8,000 babies in the UK are born with this condition.

Babies with duodenal atresia are more likely to be born prematurely and have a low birth weight.

Signs of duodenal atresia

During pregnancy

Babies usually swallow the amniotic fluid surrounding them whilst they are in the womb.  Babies with duodenal atresia are not able to do this as well.

Routine ultrasound scans done later in pregnancy at around 20 weeks can show:

  • extra amniotic fluid (polyhydramnios)
  • baby having a large stomach and duodenum filled with fluid

After giving birth

Babies with duodenal atresia may:

  • not be able to feed properly
  • vomit (usually green in colour)
  • have an enlarged stomach and duodenum shown on X-ray

Causes

The cause of duodenal atresia is not known.

The chance of it developing is the same whether or not a close relative has the condition.

Any future pregnancy is not at an increased risk.

The condition is not caused by anything the parents have done or not done during pregnancy.

Around 1 in 3 babies with duodenal atresia have Down’s syndrome.

Diagnosis

In many cases, the atresia is diagnosed on the 20 week antenatal scan.

In other cases, duodenal atresia is diagnosed on an X-ray done due to excessive or bile-stained (green) vomiting.

Once the diagnosis is confirmed, blood tests and scans are performed.

Treatment

All babies with duodenal atresia will need surgery.

While your baby waits for their operation they will have:

  • a nasogastric tube (NG tube) – a tube is placed in your baby’s nose and passed into their stomach. This will empty the stomach to prevent vomiting and swelling
  • intravenous fluids (drip) – your baby will be put on a drip so they can receive fluids and antibiotics

Feeds will be stopped until after the operation.

Surgery

The surgery for duodenal atresia is called duodeno-duodenostomy or duodeno-jejunostomy.

All babies with duodenal atresia will need open surgery under general anaesthetic.

A small cut is made in the tummy and the blocked duodenum repaired by joining it to bowel further down to ‘bypass’ the blocked area.

If possible, a trans-anastomotic tube (TAT) is inserted. The TAT goes in through the nose, passing by the duodenum and into the healthy bowel. This means milk feeds can be started straight away after surgery, without having to wait for the duodenum to heal.

After the operation

Babies are given pain relief and closely monitored on the neonatal intensive care unit (NICU).

Sometimes special nutrition will also be given into the veins through a drip. This is called a total parenteral nutrition (TPN).

Milk feeds by mouth are started when the baby is ready. This is usually around 2 weeks after the operation.

Babies can go home from hospital when they are feeding well and gaining weight.

Outlook

Most babies who have an operation do not have serious ongoing problems.

Some babies will have gastroesophageal reflux, which can cause:

  • heartburn
  • vomiting
  • slow weight gain

Conditions that are associated with duodenal atresia may cause long term health problems.

Associated conditions

Duodenal atresia is associated with other health conditions including:

  • heart, bowel and kidney conditions, although these are rare and can be quite varied
  • Down’s syndrome

Further information about Down’s syndrome

What is Down’s syndrome?

Down’s Syndrome Association: Homepage

Down’s Syndrome Association: For New Parents