Duodenal atresia

Pediatric surgery

Clinicals - History

Fact Explanation
Vomiting within hours of birth. Due to a lack of recanalization of the solid
cord stage of intestinal development causing obstruction at the duodenum .
Vomiting within hours of birth.
Due to a lack of recanalization of the solid
cord stage of intestinal development causing obstruction at the duodenum .
Vomitus most often being bilious. The atresia commonly lies below the entrance of the common bile duct into the duodenum . Vomitus most often being bilious.
The atresia commonly lies below the entrance of the common bile duct into the duodenum .
Lethargy and weight loss. These are features of dehydration and malnutrition respectively which occur due to the sustained vomiting . Lethargy and weight loss.
These are features of dehydration and malnutrition respectively which occur due to the sustained vomiting .

Clinicals - Examination

Fact Explanation
Scaphoid abdomen. Due to the absence of gas in the
intestine .
Scaphoid abdomen.
Due to the absence of gas in the
intestine .
Occasionally, epigastric fullness. This may occur initially due to the greatly dilated stomach . Occasionally, epigastric fullness.
This may occur initially due to the greatly dilated stomach .
Dry mucous membranes, reduced skin turgor, depressed fontanelles, etc. These are features of dehydration which occurs due to the sustained vomiting . Dry mucous membranes, reduced skin turgor, depressed fontanelles, etc.
These are features of dehydration which occurs due to the sustained vomiting .
Anthropometric examination. Eg: weight Malnutrition could occur due to the sustained vomiting . Anthropometric examination. Eg: weight
Malnutrition could occur due to the sustained vomiting .
Low set ears, hypotonia, flat occiput , etc on general examination. These are features of Down's syndrome which is commonly associated with duodenal atresia . Low set ears, hypotonia, flat occiput , etc on general examination.
These are features of Down's syndrome which is commonly associated with duodenal atresia .

Investigations - Diagnosis

Fact Explanation
Insertion of an orogastric tube which typically yields a significant amount of bile-stained fluid. The atresia which gives rise to obstruction commonly lies below the entrance of the common bile duct into the duodenum . Insertion of an orogastric tube which typically yields a significant amount of bile-stained fluid.
The atresia which gives rise to obstruction commonly lies below the entrance of the common bile duct into the duodenum .
Erect and recumbent plain radiography of the abdomen revealing the typical "double bubble" appearance. due to air within the stomach and the proximal duodenum, with no gas in the distal bowel . Erect and recumbent plain radiography of the abdomen revealing the typical "double bubble" appearance.
due to air within the stomach and the proximal duodenum, with no gas in the distal bowel .
Prenatal ultrasonography to detect polyhydramnios. absorption of the amniotic fluid by the fetus is impeded when the duodenum is obstructed . Prenatal ultrasonography to detect polyhydramnios.
absorption of the amniotic fluid by the fetus is impeded when the duodenum is obstructed .

Investigations - Management

Fact Explanation
Serum electrolytes revealing a hypokalemic/hypochloremic metabolic alkalosis. Due to sustained vomiting of gastric contents . Serum electrolytes revealing a hypokalemic/hypochloremic metabolic alkalosis.
Due to sustained vomiting of gastric contents .
Urinalysis revealing an increased urine specific gravity. This is a feature of dehydration which occurs due to the sustained vomiting . Urinalysis revealing an increased urine specific gravity.
This is a feature of dehydration which occurs due to the sustained vomiting .
Chromosome analysis. Down's syndrome is commonly associated with duodenal atresia . Chromosome analysis.
Down's syndrome is commonly associated with duodenal atresia .
Cardiac ultrasonography. Duodenal atresia can manifest as an extracardiac lesion of congenital heart disease . Cardiac ultrasonography.
Duodenal atresia can manifest as an extracardiac lesion of congenital heart disease .

Management - Supportive

Fact Explanation
Intravenous fluid replacement of the gastric aspirate with one half normal saline with added potassium. To correct the hypokalemic/hypochloremic metabolic alkalosis and dehydration occurring due to sustained vomiting . Intravenous fluid replacement of the gastric aspirate with one half normal saline with added potassium.
To correct the hypokalemic/hypochloremic metabolic alkalosis and dehydration occurring due to sustained vomiting .
Suction using a naso-gastric tube. While decreasing abdominal distension, it facilitates operative intervention and diminishes operative shock . Suction using a naso-gastric tube.
While decreasing abdominal distension, it facilitates operative intervention and diminishes operative shock .

Management - Specific

Fact Explanation
Duodenoduodenostomy. The end-to-end anastomosis is done to overcome the duodenal obstruction . Duodenoduodenostomy.
The end-to-end anastomosis is done to overcome the duodenal obstruction .
Placement of a gastrostomy tube at the time of operation. Infants whose duodenums are obstructed often are slow to open up and tolerate full enteral feeds . Placement of a gastrostomy tube at the time of operation.
Infants whose duodenums are obstructed often are slow to open up and tolerate full enteral feeds .

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