Atresia and stenoses of the small intestine

Duodenal atresia and stenosis [ edit | edit source ]

Duodenal atresia

Duodenal atresia A typical finding on an X-ray image in the suspension of duodenal atresia - the so-called double bubble sign

The incidence of atresia and stenoses is 1:5000-10000. 30% of patients also have Down syndrome and more than 50% of patients have associated birth defects.

Clinical course [ edit | edit source ]

Prenatally, polyhydramnios occurs due to interrupted circulation of amniotic fluid. The so-called image of two "bubbles" that are closed by the liquid occurs. Postnatally , with complete obstruction in the first 24 hours, the clinical picture of high ileus develops , which is manifested by violent vomiting with bile admixture. In 90% of cases, the obstruction is located below the papilla of Vater. In the remaining 10% of cases, the vomit does not contain bile. The doctor can observe a bulging epigastrium, sunken hypogastrium (boat-shaped belly), peristalsis is visible. Smolka is not leaving. In case of partial obstruction, the clinical manifestation is late.

Diagnostics [ edit | edit source ]

Prenatal diagnosis is performed using ultrasound screening. Postnatally, a native X-ray of the abdomen is observed in the suspension, which is typically depicted as two bubbles or levels , this applies to the stomach and the enlarged duodenum. In most cases, there is an absence of gas in the distal part of the GIT . More than 20 ml of liquid is aspirated from the stomach using a nasogastric tube. The normal volume of fluid in the stomach is 5 ml. This is followed by insufflation of gas into the stomach and thanks to this the image of the two bubbles can be reproduced on the X-ray. Contrast X-ray of the upper part of the GIT is performed to clarify the diagnosis and at the same time rule out malrotation or volvulus.

Treatment [ edit | edit source ]

The treatment is surgical, the patient undergoes a duodenoduodenal anastomosis.

Atresia and stenosis of the jejunum and ileum [ edit | edit source ]

A typical finding on an X-ray image in the suspension of duodenal atresia - the so-called double bubble sign

The incidence of atresia and stenoses of the jejunum and ileum is 1:1500.

Clinical course [ edit | edit source ]

Polyhydramnios occurs prenatally . Postnatally, in the first 36 hours, the development of the clinical picture of a moderately high ileus occurs, which results in vomiting with bile. The abdomen is distended and there are also breathing difficulties - dyspnoea , due to the high state of the diaphragm. Smolka is not leaving. Dehydration with hypochloremia and weight loss develops.

Diagnostics [ edit | edit source ]

Prenatal ultrasound shows dilatation of intestinal loops. Postnatally, a native X-ray of the abdomen in suspension is observed.

Treatment [ edit | edit source ]

The treatment is surgical, the atretic or stenotic section of the intestine is removed and an end-to-end anastomosis is performed.

• Gallery of diagnostic X-ray images in patients with various obstructions of the small intestine
  

  Irigography in the previous patient with jejunal atresia IV. type
  

  X-ray of the hanging abdomen in a full-term newborn with jejunal atresia IV. type
  

  X-ray image one hour after administration of contrast to the stomach to confirm the diagnosis of duodenal atresia
  

  Not entirely typical finding on X-ray of the hanging abdomen in a slightly premature newborn with duodenal atresia

Links [ edit | edit source ]

Related Articles [ edit | edit source ]

• Congenital atresias and stenoses of the gastrointestinal tract
  • Esophageal atresia
  • Congenital hypertrophic pyloric stenosis
  • Anal and rectal atresia
• Superior mesenteric artery syndrome
• Bowel malrotation and volvulus
• Meconium ileus
• Megacolon congenitum

References [ edit | edit source ]

ŠNAJDAUF, Jiří and Richard ŠKÁBA. Pediatric surgery. 1st edition. Prague: Galén, 2005.  ISBN 807262329X .

HOLCOMB III, George W., J. Patrick MUPRHY, and Daniel J. OSTLIE. Ashcraft's Pediatric Surgery. 6th edition. Elsevier, 2014.  ISBN 145574333X .

MUNTAU, Ania Carolina. Pediatrics. 4th edition. Prague: Grada, 2009. p. 365.  ISBN 978-80-247-2525-3 .