Skip to Main Content

+

  • • Other etiologies:

    • -Intestinal atresia

      -Intestinal duplication

      -Mesenteric or omental cyst

      -Meckel diverticulum

      -Foreign body

      -Meconium ileus

      -Annular pancreas

    • 10-20% of patients with abdominal wall defects have intestinal atresia

    • 90-95% of duodenal atresia is distal to ampulla

    • 90% of jejunoileal atresias have complete atresia

    • Distal ileum most common site of atresia

    • 3.6-20% of patients have multiple areas of intestinal atresia

    • Patent accessory pancreatic duct common with annular pancreas

    • 50% of duodenal atresia with complete atresia and 50% with webs or diaphragm

    • Trisomy 21 associated with duodenal atresia

    • 10-20% of patients with cystic fibrosis develop meconium ileus (concretions of meconium usually found just proximal to ileocecalvalve secondary to decreased pancreatic exocrine activity)

    • 33-50% of patients with meconium ileus undergo proximal volvulus, perforation, or atresia that occurs in utero

    • Cardiac anomalies associated with duodenal atresia

    • 5-10% of patients with Meckel diverticulum will present with obstruction secondary to volvulus or intussusception

    • 95% of foreign bodies that pass beyond the gastroesophageal junction pass through remainder of GI tract uneventfully

    • Mesenteric cysts 2-fold more common than omental cysts

    • Omental and mesenteric cysts diagnosed before 10 years of age

++

Epidemiology

+

  • • Intestinal atresia: 3.5/10,000 births

    • All congenital duodenal obstructions: 1/6000-1/10,000 births

++

Symptoms and Signs

+

  • • Bilious emesis

    • Abdominal distention

    • Irritability

    • Maternal polyhydramnios

    • Failure to pass meconium

    • Umbilical cord ulceration (rarely with intestinal atresia)

    • Abdominal mass if mesenteric/omental cyst or duplication

++

Laboratory Findings

+

  • • Test for CFTR mutations or sweat chloride analysis in patients with meconium ileus to diagnose cystic fibrosis

++

Imaging Findings

+

  • Abdominal x-ray: Shows transition point of gas (soap bubble appearance intraluminal in meconium ileus)

    Upper or lower GI series: Demonstrates transition point of obstruction (concretions in meconium ileus)

    CT scan or US: May demonstrate cystic mass with mesenteric or omental cysts

++

Rule Out

+

  • • Malrotation

+

  • • History and physical exam

    • Abdominal x-ray

    • Upper and/or lower GI series

    • CFTR or sweat chloride (to document cystic fibrosis in patients with meconium ileus)

    • Echocardiogram in patients with duodenal atresia

++

Surgery

+

  • • Primary anastomosis following short segmental resection (if web associated) after careful exam for other sites of obstruction or atresia

    • Duodenoduodenostomy for annular pancreas and duodenal atresia (possible excision of web for atresia)

    • Operative retrieval of foreign body if symptomatic, or an alkaline battery, or if persists in 1 location (no transition) for 1 week or more or several weeks in stomach

++

Medications

+

  • • Nonoperative management possible in 65% cases of meconium ileus, enemas using gastrograffin, tween-80, or N-acetylcysteine are beneficial

++

Complications

+

  • • Short bowel syndrome if left with < 40 cm

    • Damage to ampulla ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.