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Duodenal atresia

Introduction
congenital duodenal atresia is one of the more

common intestinal anomalies treated by pediatric


surgeons, occurring 1 in 2500-5000 live births. In 2540% of cases, the anomaly is encountered in an infant with trisomy 21 (Down syndrome).The definitive intervention to correct the anomaly is surgical and

consists of duodenoduodenostomy in the newborn


period.

Definition
Duodenal atresia is a condition in which the first

part of the small bowel (the duodenum) has not


developed properly. It is not open and cannot

allow the passage of stomach contents.

Causes, incidence, and risk factors


The cause of duodenal atresia is unknown, but it is

thought to result from problems during an embryo's


development in which the duodenum does not

normally change from a solid to a tube-like structure.

Cont

Duodenal atresia is seen in more than 1 in 25005000 live births. Approximately 25 -40% of infants with duodenal atresia have Down syndrome. Duodenal atresia is often associated with other birth defects.

Symptoms
Upper abdominal swelling may or may not be present

Early vomiting of large amounts, which may be


greenish (containing bile) Continued vomiting even when infant has not been fed for several hours Absent urination after first few voiding Absent bowel movements after first few meconium stools

Diagnostic Evaluation
fetal ultrasound

Abdominal x-ray

Treatment
Medical Therapy
No medical therapies are available for the definitive
treatment of duodenal atresia or stenosis; all treatment

is surgical. Adequate intravenous (IV) hydration, total


parenteral nutrition, and gastric decompression are essential until the neonate has been stabilized for surgical repair.

Surgical Therapy
Duodenal atresia and stenosis are treated surgically. In

patients with duodenal obstruction, a


duodenoduodenostomy is the most commonly performed procedure.

A duodenojejunostomy is now uncommonly performed


due to its higher risk of long-term complications. Duodenal repair may be performed via a right upper quadrant incision, an umbilical incision, or laparoscopically, depending on surgeon preference.

Complications
Other birth defects

Dehydration

After surgery, there may be late complications such as:


Swelling of the first part of the small bowel
(megaduodenum) Problems with movement through the intestines Gastro esophageal reflux

Bibliography
Marlow, text book of pediatric nursing, 6th edition , Saunders an imprint of Elsevier , page no. Wongs, essential of pediatric nursing, 8th edition, Elsevier sector-16 Nodia, page no. 825-833. Parul data, pediatric Nursing, 2nd edition, jaypee brother medical publisher(P) ltd. Mew delhi, page no. http://columbusfetalmedicine.org/services-duodenal-atresia.cfm http://childrens.memorialhermann.org/texas-fetal-center/duodenal-atresia-repair/ http://www.ajronline.org/content/192/5/1269.full http://www.nlm.nih.gov/medlineplus/ency/presentations/100165_3.htm