The duodenum is the first part of the small bowel, located between the stomach and the remainder of the small intestine. It is directly connected to the stomach. Food digestion begins in the duodenum. Duodenal atresia is a narrowing or blockage in the duodenum. The narrowed area blocks the passage of food from the stomach moving freely into the intestine.
The cause of pediatric duodenal atresia is not yet known. It is congenital, meaning it happens before your baby is born. Duodenal atresia is seen in about 1 of every 5,000 to 10,000 live births. Infants born with it often have other problems at birth. About 30 percent of infants with duodenal atresia also have Down Syndrome.
You may have a routine prenatal ultrasound done while you are pregnant to learn about the health of your baby. Duodenal atresia is usually found by ultrasound during pregnancy, but sometimes it is not diagnosed until birth. If your baby has duodenal atresia, the ultrasound may show fluid in your baby’s stomach and part of his duodenum, but no fluid beyond that. This is known as the double-bubble sign.
During pregnancy, duodenal atresia is sometimes associated with increased amniotic fluid in the uterus, which is called polyhydramnios. This increase in amniotic fluid is caused by the inability of the fetus to swallow the amniotic fluid and absorb it in their digestive tract.
A baby with duodenal atresia cannot be treated before birth. Your doctor will have a detailed plan to watch your pregnancy very closely. Ideally you will be able to have a normal vaginal delivery. If a cesarean section (C-section) is needed your doctor will discuss this with you. It is important to call your doctor if you have any questions or concerns during your pregnancy.
If this problem is found while you are pregnant, you will continue to receive care from your obstetrician and you may also be referred to the Ohio Fetal Medicine Collaborative (OFMC) for more consulting or care.
Through the OFMC, you will see a doctor who specializes in taking care of high-risk patients. You will also meet with a pediatric specialist at Nationwide Children’s Hospital to learn more about your baby’s care after he or she is born. Nurse coordinators will be available to help answer your questions and concerns; guide you through your pregnancy; and prepare you for what to expect.
You will deliver your baby at a hospital that is prepared to care for high-risk babies.
At the delivery hospital, a neonatologist (a doctor who specializes in treating newborns) will observe your baby. This may include the following:
Your baby will require surgery to repair the duodenal atresia. However, surgery for this condition is not an emergency as long as the baby is receiving intravenous fluids and nutrients. Depending on other conditions your baby may have, the surgery is done within 1 to 2 days after birth. The pediatric surgeon will remove the affected area in your baby’s intestine and reconnect the healthy ends together. A gastrostomy tube (G-tube) may be placed in the stomach to help provide nutrition. The pediatric surgeon will discuss this and all options with you.
After surgery, your baby will receive care in the hospital’s neonatal intensive care unit. Your baby will need to be on a breathing machine until he or she is fully recovered from surgery.
Other treatments your baby will probably need after surgery are:
Feedings are started once the intestines are fully healed after surgery. Feedings of breast milk or formula are started very slowly with either the bottle, nasogastric tube (NG) or a gastrostomy tube. The tube is removed when your baby’s intestine works properly.
The total length of time your baby will stay in the hospital will vary. It will depend on whether your baby is born with other health issues or if there are complications after surgery. The usual length of stay in the hospital is about 6 to 8 weeks after surgery. If there are complications the expected hospital stay may be longer.
Your baby will need regular follow-up appointments to measure growth, development and nutrition. You will want to find a local pediatrician to take care of the routine checkups, immunizations, and doctor’s visits. The nurse coordinator can help if needed. The pediatric surgeon will follow up with your baby’s surgical needs.