Duodenal Atresia in Children

00:02 Moving on to duodenal atresia.

00:06 So here’s a classic case, a newborn with Down’s syndrome and abdominal distention.

00:12 This four-day old infant with known Down’s syndrome presents with abdominal distension suspicious of obstruction.

00:19 A child is vomiting just about everything he gets.

00:23 Clearly, Down’s syndrome and abdominal distention is a risk factor for duodenal atresia.

00:31 So intestinal atresias, all of them, are basically a failure of the hollow viscous organ to develop properly.

00:40 Instead of being hollow, it’s constricted and obstructs passage of food.

00:45 There’s a spectrum of severity, some are very badly atretic and some are only minimally atretic.

00:52 But what we do know is duodenal atresia is very closely associated with trisomy 21 or Down’s syndrome.

00:58 That is a very high-yield point on an exam.

01:01 Remember that connection.

01:03 So typically, the stenosis of any type of intestine, which is more common in the duodenum, occurs between two segments of bowel with or without a separating web.

01:16 The atresia will be a connecting fibrous band between those two segments of bowel and it can result in two blind pouches of bile, that’s the most common kind.

01:29 So what do we do in terms of diagnostic testing? Typically, we can get abdominal radiographs.

01:36 They will show obstruction, maybe pneumoperitoneum if it’s gone very far, and perhaps meconium peritonitis if it’s been left going too long.

01:46 The classic finding that is likely to be on your test is the double bubble sign.

01:52 What you will see is two round air-filled locations on an intestinal X-ray.

01:59 This is a picture of colonic atresia, not the double bubble sign, but the idea is still there.

02:05 You have an area where fluid is getting and then where fluid is not getting.

02:10 Sometimes, we’ll do contrast studies such as in this image, where an upper GI series may reveal a malrotation in addition to the double bubble.

02:20 In this case, where a patient has a microcolon, you can see an area where the colon is atretic.

02:28 Remember, and this is also high-yield for your exam, microcolon is associated with maternal gestational diabetes.

02:37 So duodenal atresia, Down’s syndrome, microcolon, maternal gestational diabetes.

02:45 Here is the double bubble sign.

02:47 And you can see the stomach filled with air and the duodenum filled with air as well.

02:53 The reason why there’s a line there is these are largely fluid contents because the child is presumably eating breast milk or formula, so it layers out in a gravitational manner.

03:04 Notice there is no gas distally.

03:06 This child is incapable of creating gas distally because nothing is getting into the distal intestinal compartment.

03:13 It is impossible to miss this for more than a few days because the child will pass away unless this is surgically corrected.

03:19 Food is not going through.

03:23 The surgical resection is essentially that.

03:26 They take out the atretic bowel and they put the healthy pieces of bowel back together as an anastomosis.

03:32 This allows the baby to recover and have full function.