Abstract
Background
The diagnosis of duodenal atresia is commonly made prenatally, either as an isolated lesion or due to its association with other chromosomal abnormalities (Robertson et al. in Semin Perinatol 18:182–195, 1994; Hemming and Rankin in J Prenat Diagn 27:1205–1211, 2007). The aim of this study was to describe the prevalence of associated anomalies, prenatal diagnostic accuracy and survival of cases of congenital duodenal atresia in our institution.
Methods
All cases of duodenal atresia registered with our local congenital anomaly register over a 10-year period, 1995–2004 inclusive, were studied, including those resulting in termination of pregnancies, stillbirths, intrauterine deaths and neonatal deaths. To ensure high-case ascertainment, data were cross checked with prenatal ultrasound, cytogenetic laboratory, pathology department and neonatal surgical data base. Data were analysed for associated anomalies, accuracy of prenatal diagnosis and neonatal outcomes.
Results
A total of 65 patients were initially diagnosed as having duodenal atresia, of these 4 were subsequently excluded (1 postnatal normal bowel and 3 high jejunal atresias). In the remaining 61 cases, 35 (57%) had an association with other congenital abnormalities and 26 (43%) were isolated anomalies. Thirty-five were male and 26 female (M:F = 1.4:1). Twenty-one out of 29 (72%) patients prenatally diagnosed, compared with 14 out of 32 (44%) patients diagnosed postnatally had associated anomalies. Duodenal atresia was suspected on routine prenatal ultrasonography at 20-week gestation in 33 cases and confirmed in 29 (48%) cases with 4 false-positive diagnoses (1 normal bowel and 3 high jejunal atresias). No prenatal diagnosis was made in 32 (52%) babies. Of the 61 cases, 53 were live births with 2 early neonatal deaths (1 cardiac and 1 VACTERL), 5 terminations, 2 intrauterine deaths and 1 stillbirth (Fig. 3). Overall neonatal survival was 96% (51 cases). Mortality in the group diagnosed prenatally was 34 % (10 cases).
Conclusion
This study shows an overall increased association of duodenal atresia with Down’s syndrome. In the group diagnosed prenatally, mortality as well as the association with other congenital anomalies was found to be higher. We have demonstrated a greater prenatal diagnostic accuracy, but confirm postnatal outcomes similar to previous studies.
Similar content being viewed by others
References
Robertson FM, Crombleholme TM, Paidas M et al (1994) Prenatal diagnosis and management of gastrointestinal anomalies. Semin Perinatol 18:182–195
Hemming V, Rankin J (2007) Small intestinal atresia in a defined population: occurrence, prenatal diagnosis and survival. Prenat Diagn 27:1205–1211
Fonkalsrud EW, de Lorimer AA, Hays DM (1969) Congenital atresia and stenosis of the duodenum: a review compiled from the members of the surgical section. Am Acad Pediatr 43:79–83
O’Rahilly R, Muller F (1996) Human embryology and teratology. Wiley-Liss, New York, p 229
Zimmer EZ, Bronshtein M (1996) Early diagnosis of duodenal atresia and possible sonographic pitfalls. Prenat Diagn 16:564–566
Phelps S, Fisher R, Partington A, Dykes E (1997) Prenatal ultrasound diagnosis of gastrointestinal malformations. J Pediatr Surg 32:438–440
Malone FD, Crombleholme TM, Nores JA, D’Alton ME (1997) Pitfalls of the ‘double bubble’ sign: a case of congenital duodenal duplication. Fetal Diag Ther 12:298–300
Dewbury KC, Aluwihare APR, Birch SJ (1980) Prenatal ultrasound demonstration of a choledochal cyst. Br J Radiol 53:906
Lawrence MJ, Ford WDA, Furness ME, Hayward T, Wilson T (2000) Congenital duodenal obstruction: early antenatal ultrasound diagnosis. Pediatr Surg Int 16:342–345
Hertzberg BS (1994) Sonography of the fetal gastrointestinal tract: anatomic variants, diagnostic pitfalls and abnormalities. AJR 162:1175–1182
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Choudhry, M.S., Rahman, N., Boyd, P. et al. Duodenal atresia: associated anomalies, prenatal diagnosis and outcome. Pediatr Surg Int 25, 727–730 (2009). https://doi.org/10.1007/s00383-009-2406-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-009-2406-y