Duodenal atresia means the duodenum, which is the first part of the small intestine just beyond the stomach, is closed off rather than being a tube. This stops food and fluid passing from the stomach into the intestines.This page explains about duodenal atresia, how it is treated and what to expect when a child comes to Great Ormond Street Hospital (GOSH) for treatment.
How is duodenal atresia diagnosed?
Duodenal atresia can sometimes be discovered during pregnancy as it often shows up on antenatal ultrasound scanning. Some babies with this condition are born prematurely. Many babies appear well at birth but when they start to feed, they are sick and their vomit may be green. An X-ray scan can confirm this diagnosis.
Duodenal atresia is a rare condition and occurs in about one in 6,000 births. It can be associated with other problems, so the doctors will examine a child closely to check if this is the case. One third of all children with duodenal atresia have Down’s syndrome (trisomy 21).
How is it treated?
Duodenal atresia is repaired in an operation under general anaesthetic which lasts around 90 minutes. The operation to repair the duodenal atresia can either be carried out using open surgery or sometimes using laparoscopic (keyhole) surgery.
Are there any alternatives?
No - duodenal atresia always requires treatment to allow a baby to feed.
What happens before the operation?
The baby will be transferred to the hospital soon after birth. To begin with, the child will be nursed in an incubator and will have a nasogastric tube passed through his or her nose into the stomach. This will drain off the contents of the stomach and stop the child feeling and being sick. It also releases any excess air from the stomach, which could make the child uncomfortable. They will also have an intravenous infusion (drip) of fluids and medicines.
The surgeon will explain about the operation in more detail, discuss any worries families may have and ask them to sign a consent form giving permission for the child to have the operation. An anaesthetist will also visit to explain about the anaesthetic.
What does the operation involve?
The surgeon will open the blind end of the duodenum and connect it to the rest of the intestine. This provides a clear passage for food and fluid to travel from the child’s stomach to his or her intestine.
Are there any risks?
All surgery carries a small risk of bleeding during or after the operation. During the operation, the surgeon will minimise any bleeding by sealing off the blood vessels affected. There is a very small chance that nearby structures in the abdomen could be damaged during surgery, but this is a very rare occurrence.
There is a chance that the area where the two ends of bowel were joined could start to leak, allowing bowel contents to escape into the abdomen. This is usually treated with antibiotics, but a second operation may be needed to check the leaking portion.
Every anaesthetic carries a risk of complications, but this is very small. The anaesthetist is a very experienced doctor who is trained to deal with any complications.
There are two ways of carrying out the operation: using laparoscopic (keyhole) surgery or open surgery. The surgeon will discuss the most appropriate method. There is a small possibility that having started the procedure using laparoscopic surgery, it will not be possible to repair the atresia using this method. The surgeon will then change to use open surgery during the same operation.
It can take a while after the operation for the bowel to start working properly, so the child may need to be fed intravenously using total parenteral nutrition (TPN) for a while. This affects many children and is explained further in the next section.
What happens afterwards?
The baby will come back to recover either on the intensive care unit or our surgical ward. They will be able to have visitors as soon as they are settled. All babies are closely monitored after the operation, and so the baby will be connected to monitors to check their breathing, heart rate and oxygen levels. If the child needs help with breathing, they will be nursed on the intensive care unit and connected to a ventilator. They will also be given pain relief through the intravenous infusion (drip).
While the child’s intestines recover and start to work, they may be fed through a tube into their veins. This is called total parenteral nutrition or TPN. This will gradually be replaced by breast or bottled milk, given through the nasogastric tube when the child is able to tolerate this. As the baby recovers, they will be able to feed from the breast or bottle. Over time, the drips and monitors will be removed one by one.
The nurses on the ward will encourage families to look after their baby as much as they feel able while the child is recovering. This can be daunting, especially while the baby is connected to drips and monitors, but it will become easier with time. If anyone is worried about caring for their baby, they can talk to the nurses. The child will be able to go home or be transferred back to a local hospital once they are feeding properly and gaining weight. Most children stay in hospital for one to two weeks, but occasionally a longer stay is needed. A local health visitor or community paediatric nurse will visit regularly.
We send details of any outpatient appointments in the post, soon after they leave hospital.
What is the outlook for children with duodenal atresia?
If the duodenal atresia occurs on its own with no other associated problems, the outlook is very good, with the majority of children growing up to live normal lives. The outlook for children with duodenal atresia and other conditions varies, depending on how severe the other problems are.
Some children who have had duodenal atresia develop a problem with gastrooesophageal reflux when they are older. This is where the contents of their stomach flow back up the oesophagus (gullet) causing pain and irritation.