• Other etiologies:
• 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
• Intestinal atresia: 3.5/10,000 births
• All congenital duodenal obstructions: 1/6000-1/10,000 births
• Bilious emesis
• Abdominal distention
• Maternal polyhydramnios
• Failure to pass meconium
• Umbilical cord ulceration (rarely with intestinal atresia)
• Abdominal mass if mesenteric/omental cyst or duplication
• 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
• 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
• 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
• Nonoperative management possible in 65% cases of meconium ileus, enemas using gastrograffin, tween-80, or N-acetylcysteine are beneficial
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