LO 4

Duodenal Atresia
 Epidemiology
• 1 per 5000 to 10,000 live births
• Affecting boys more commonly than girls
• More than 50% of affected patients have associated congenital
 Etiology
• Congenital duodenal obstruction
• Intrinsic or extrinsic gastrointestinal lesion
Intrinsic lesion  caused by a failure of recanalization of the
fetal duodenum
Extrinsic form defects in the development of neighboring
structures
 Diagnosis
• History of polyhydramnios
• Prenatal ultrasonography detect two fluid-filled structures
consistent with a double bubble in up to 44% of cases
• Most cases of duodenal atresia are detected at between 7 and
8 months of gestation
• The diagnostic radiographic presentation (upright abdominal
radiograph)  “double bubble” sign with no distal bowel gas
 Pre-operative care
• Appropriate resuscitation
• Correction of fluid balance and electrolyte abnormalities
• Perenteral nutrition via central catheter line
 THERAPY / OPERATION
• Surgical correction of duodenal obstruction is not urgent
• Various techniques:
 Side-to-side duodenoduodenostomy,
 Diamond-shaped duodenoduodenostomy,
 Partial web resection with heineke-mikulicz–type duodenoplasty,
 Tapering duodenoplasty
• Today, the procedure of choice is either laparoscopic or open
duodenoduodenostomy
• Long side-to-side duodenoduodenostomy, although effective, is
associated with a high incidence of anastomotic dysfunction and
prolonged obstruction
• Duodenojejunostomy  blind-loop syndrome appears to be more
common
• Gastrojejunostomy  high incidence of marginal ulceration and
bleeding
• Or the open approach  right upper quadrant supraumbilical
transverse incision is made
• After mobilizing the ascending and transverse colons to the left, the
duodenal obstruction is readily exposed
 POST-OPERATIVE CARE
• Total parenteral nutrition (tpn) is continued
• Feedings may be started when the volume of the nasogastric
output has
• Diminished and its color has lightened and it becomes clear
several days to a week
• Small feedings are then initiated with volume and
concentration advanced as tolerated
• The majority may be discharged within one to several weeks
 Complications
Intraoperative
• Incorrect identification of the site of obstruction most
commonly occurs when a long, floppy web (windsock deformity)
is present
• More than one obstruction present (rare)
• Postoperative
The most common  prolonged feeding intolerance
In general, if no specific difficulties were encountered at the
initial procedure, there should be concern if relatively normal
function has not been achieved by 3 weeks