#1 cause of duodenal obstruction in newborns < 1 week

MC type of intestinal atresia

MC type: distal to ampulla of vater (80%) → causes bilious emesis

Etiology → ischemic insult vs genetics

RF: polyhydramnios in mother, prematurity, Down’s syndrome, biliary atresia

Non-bilious emesis in the first few days of life

No contrast flowing into 2nd portion of duodenum

20% have Down’s syndrome and annular pancreas

• Also associated with cardiac, renal and GI anomalies (malrotation)
• Must do workup for cardiac anomalies prior to surgery Must get an echo prior to surgery

Dx: X-ray will show classic double bubble sign (air in stomach and distal duodenum)

• Once you see this, you MUST order UGI to rule out malrotation

NOTE: The finding of double bubble sign with distal air in bowel can ALSO indicated duodenal stenosis, duodenal web or annular pancreas

If no distal gas → upper GI contrast is not required as it will fill the stomach and cannot reliably rule out malrotation

Tx: duodenoduodenostomy or duodenojejunostomy

Persistent obstruction after surgery = duodenal webs → resection of webs via longitudinal duodenostomy at the time of initial surgery if found