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Early Detection and Multidisciplinary Care: Successful Management of Duodenal Atresia

Early Detection and Multidisciplinary Care: Successful Management of Duodenal Atresia 1024 737 Pam Georgiana
person in scrubs holding a baby

The team in the Fetal Center at Nationwide Children’s Hospital shares their comprehensive approach for best possible outcomes. 

When a routine ultrasound reveals two enlarged, fluid-filled bubbles in the baby’s abdomen, known as the “double bubble” sign, pregnant patients and their families often feel scared and concerned. These bubbles indicate duodenal atresia, a congenital condition where the duodenum is blocked or narrowed. Duodenal atresia affects about 1 in 5,000 live births. 

Recently, Karen A. Diefenbach, MD, director for Minimally Invasive Surgery at Nationwide Children’s and professor in the Division of Pediatric Surgery at The Ohio State University College of Medicine, Oluseyi K. Ogunleye, MD, fetal surgeon at Nationwide Children’s, and a team of practitioners in Nationwide Children’s Fetal Care Center wrote and presented a case study on their team approach to the prenatal diagnosis and postnatal management of duodenal atresia. The case study was published in NeoReviews.

A 30-year-old gravida 2, para 1 pregnant woman underwent fetal ultrasonography at 33 weeks, where duodenal atresia was indicated. Her initial pregnancy was uncomplicated, and routine anatomy ultrasonography at 20 weeks did not reveal any signs of duodenal atresia. The DNA screening was normal. During the initial consultation, physicians were optimistic about the patient’s recovery and long-term outcome because the diagnosis appeared to be an isolated obstruction. 

“We discussed the initial management at the time of delivery with the family, as well as the planned preoperative evaluation, operative and postoperative management, expected recovery period, and potential complications and long-term outcomes,” Dr. Diefenbach explained. “Our goal was to prepare the family for what will happen when the baby is born, give them time to process the information, ask questions, and understand the risks and complications.”  

Due to the potential risk of other serious abnormalities such as trisomy 21 or congenital heart disease, a multidisciplinary team approach is essential for caring for both the mother and baby. The Fetal Center at Nationwide Children’s tailors prenatal and postnatal management to the patient based on whether the obstruction appears isolated or associated with other organ involvement. The team typically includes a nurse coordinator, maternal-fetal medicine specialist, neonatologist, pediatric surgeon, feeding specialists and social worker. Additional experts such as a pediatric cardiologist, geneticist and urologist may be involved depending on concurrent diagnoses.  

The team supports the patient and family in determining the best care for their infant, ensuring that all care discussions are family-led and culturally congruent. Information is provided in an unbiased manner and emphasizes that decisions made during the neonatal period should remain flexible as physicians gather more information. 

The care team monitored the patient closely for the rest of the pregnancy. Follow-up imaging showed no additional structural defects or markers for trisomy 21, and fetal growth appeared normal. Labor was induced at 38 weeks, and a female infant weighing 2,636 g (32nd percentile) was delivered. The infant was active and vigorous without respiratory support. She was admitted to the Newborn Intensive Care Unit (NICU) and received intravenous fluids. Her cardiac and respiratory examinations were normal, and an abdominal examination showed a distended abdomen and normal bowel sounds. Postnatal radiography demonstrated a classic double bubble image with no distal bowel gas, consistent with duodenal atresia. 

On the second day after birth, the infant underwent laparoscopic repair, where doctors created a bypass around the obstruction. Postoperatively, the infant received parenteral nutrition until she had return of bowel function. She began passing stools on postoperative day three and did not require supplemental oxygen during her NICU stay. The infant was discharged on postoperative day 15 and has had no complications in the last five months. 

This case underscores the positive outcomes that can be achieved with early detection, timely surgical intervention, and a team approach to care for duodenal atresia. Delayed diagnosis can lead to complications such as electrolyte abnormalities, nutritional deficiencies, and aspiration. However, when diagnosed early, infants with isolated duodenal atresia generally have a good outcome after surgical repair, with a survival rate of over 90%. This optimistic outlook should reassure parents and medical practitioners alike. 

“Setting appropriate expectations at the prenatal consultation and postnatal evaluation, identifying additional diagnoses and their impact on outcomes, and providing support through clear communication, social support, and counseling is crucial for parents to understand the expected recovery and long-term outcomes associated with duodenal atresia,” Dr. Diefenbach says. 

 Reference:

Ogunleye O, Griffin K, Xia J, Jackson J, Etchegaray A, Olutoye O, Diefenbach KA. Duodenal Atresia: Prenatal Diagnosis and Postnatal Management. Neoreviews. 2024;25(3):e180-e186. doi:10.1542/neo.25-3-e180.

Image credit: Adobe Stock

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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