Intestinal Atresia

Aka: Intestinal Atresia, Duodenal Atresia, Atresia of Small Intestine

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II. History

  1. Prenatal polyhydramnios in Duodenal Atresia
    1. Distal Intestine blocked from amniotic fluid absorption

III. Signs

  1. Duodenal Atresia
    1. Bilious Emesis
    2. Absent Abdominal Distention
    3. Typically presents early, while in newborn nursery
  2. Distal Small Bowel atresia (jejunum, ileum)
    1. Symptom onset delayed 12 to 24 hours after first feeding
    2. Bilious Emesis
    3. Abdominal Distention
    4. No meconium passage in first 24 hours in 80% of children

IV. Differential Diagnosis

  1. Bilious Emesis and/or delayed meconium passage
    1. Hirschprung Disease
    2. Meconium Ileus (Cystic Fibrosis)
    3. Malrotation with Volvulus

V. Imaging

  1. Abdominal XRay
    1. Double Bubble Sign in Duodenal Atresia (large Stomach air filled bubble, smaller duodenal air filled bubble)
    2. Double-Bubble is also seen in Midgut Volvulus
  2. Water soluble enemas
    1. Differentiates atresia from meconium ileus and Hirschprung Disease
    2. Colon contracted in Intestinal Atresia (obstruction prior to ileocecal valve)
  3. Abdominal Ultrasound
    1. Differentiates atresia from meconium ileus and Intestinal Malrotation

VI. References

  1. Jones (2022) Crit Dec Emerg Med 36(2): 14-5

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