Duodenal atresia

[stnurse421]

A few weeks ago, I observed in the Pediatric OR in my clinical rotation. I went in and saw the repair of duodenal atresia. I have researched it and have a basic understanding of what it is. However, I was wondering if anyone could tell me of any experiences they have had with this. I am not sure how the patient did post-op and/or how she is doing now. She was only four week old and had a lot of other problems on top of the duodenal atresia. Please share any information with me!

Thanks!:)

[Jolie, BSN]

Was this a term baby or preemie?

I've cared for 2 preemies who were diagnosed with duodenal atresia at birth. In both cases, surgery was delayed since the babies were so small and had to be npo initially anyway. They were stabilized, weaned from the vent, allowed to grow and nourished by TPN and lipids until they were ready for surgery. They both returned from the OR with gastrostomy tubes which were initially used for drainage, and then feedings. The tubes were removed prior to discharge when the babies were feeding well and gaining weight.

I also cared for a term girl who was admitted to the NICU with mild respiratory distress. As a matter or routine, we did a chest X-ray, which also included much of the abdominal field. The abdominal portion of the X-ray revealed a "double bubble" sign which is indicative of a duodenal atresia. A double bubble shows the air-filled stomach bubble, which is normal, right next to the air-filled bubble of the doudenum, which is abnormal. The duodenum should be open to the jejunum, allowing air to pass through the duodenum, jejunum, ileum and large intestine. It was night time and there was no radiologist available to read the film, so I called the pediatrician and told him what I thought I saw on the X-ray. I then checked the baby a little more closely and saw some signs suspicious of Down's Syndrome, which was later confirmed by chromosome testing. (25% of babies with duodenal atresia also have Down's.)

In a way, it was fortunate that this baby came to us with mild respiratory problems. Had we not gotten the chest X-ray, her GI problems probably would have gone undiagnosed for a day or more, possibly leading to dehydration and glucose instability. As it turned out, her respiratory status stabilized with only an oxyhood, and she was kept hydrated with IV fluids until her surgery. She was transferred to another hospital for surgical care, so I lost touch with her parents. They were very devoted parents and I'm sure she is thriving under their care.

It is interesting that none of these cases was diagnosed prior to birth, as duodenal atresia can be picked up on ultrasound prenatally. It just shows how important our initial assessments of newborns are!

Good luck as you complete school!