Intestinal Atresia
Intestinal atresia is a blockage of the intestines that is present when a baby is born. It is categorized by the parts of the intestine that are blocked. There are three main types of intestinal atresia.
- Duodenal atresia – Duodenal atresia is when the blockage is located in the duodenum, which is at the beginning of the small intestine near the stomach. In duodenal atresia, there is only one obstruction. Some babies with duodenal atresia may also be diagnosed with Down syndrome.
- Jejunoileal atresia – Jejunoileal atresia, also called small bowel atresia, is a blockage in the lower two areas of the small intestine (jejunum or ileum). Usually there is one blockage; very rarely there are multiple obstructions present. Occasionally jejunoileal atresia is associated with a twisting of the intestine that can lead to short bowel syndrome.
- Colonic atresia – Colonic atresia is a blockage in the colon (large intestine) and is very rare.
What causes intestinal atresia?
Duodenal atresia occurs when your baby’s duodenum does not open properly during development in utero. Jejunoileal atresia is caused by an insufficient flow of blood to your baby’s intestines during development in utero.
How is intestinal atresia diagnosed?
Duodenal and jejunoileal atresia can be diagnosed either during pregnancy or after birth.
Prenatal Diagnosis
Ultrasounds during the second and third trimester can be used to diagnose intestinal atresia.
Duodenal atresia is often diagnosed by an ultrasound image displaying a “double bubble.” The first “bubble” is the fluid-filled stomach and the second bubble is the fluid trapped in the duodenum that is unable to travel down the intestinal tract due to the blockage.
An ultrasound might also detect polyhydramnios (an excess of amniotic fluid) which is a risk factor for having a baby with intestinal atresia, though there are many other reasons for this to occur. An ultrasound might also show one or several loops of dilated bowel.
If you receive a prenatal diagnosis, CHOC’s pediatric surgeons can provide expert counseling to help you prepare for your baby’s safe delivery and for a surgery that will happen shortly after your baby is born.
Postnatal Diagnosis
When intestinal atresia is not diagnosed prenatally, it will usually be diagnosed in the first days after birth. Babies born with intestinal atresia typically show signs as they begin eating. These signs may include vomiting, producing green bile, a bloated stomach or being unable to produce a bowel movement.
A diagnosis after birth is often made by X-ray.
Very rarely there may be a partial blockage that is not diagnosed immediately because food is able to move through the GI tract. In this case the diagnosis may not be made until your baby is a few months old.
CHOC Pediatric Surgery for Intestinal Atresia
Whether diagnosed prenatally or after birth, surgery will likely occur within the first few days after delivery. The surgical procedure will be determined by the type of intestinal atresia your baby is diagnosed with.
Surgery to repair intestinal atresia involves removing the blockage and reconnecting your baby’s intestine. The amount of blockage will determine the complexity of the surgery your baby will need.
After surgery, your baby may have a breathing tube for one to two days, a nasogastric tube in their nose or mouth, and an IV to receive medication nutrition until their intestines recover. Regular food will be gradually introduced over a week until your baby is able to eat normally.
Your doctor will carefully explain your baby’s type of atresia and the surgical procedure needed to remove it. Be sure to ask questions if there is anything you don’t understand.
After Surgery
Please call your child’s doctor if:
- Your baby begins running a fever higher than 101 degrees Fahrenheit
- Your baby isn’t urinating or has a decreased number of wet diapers
- Your baby is not pooping
- Your baby’s belly is bloated
- Your baby is struggling with feeding and is vomiting
- Your baby’s incision begins to look red, swollen or otherwise infected.
Life After Intestinal Atresia Surgery
While most children who have had surgical repair of their small bowel will go on to live a very healthy life, some may continue to have complications.
Complications of intestinal atresia are not frequent but may include bowel management, feeding or a blockage of the intestines later in life due to scar tissue. Some children may have a short bowel syndrome diagnosis, which will be known soon after surgery. Short bowel syndrome is a disorder that makes it hard for nutrients to be absorbed because the small intestine is not functioning properly. For most people, short bowel syndrome is treated with changes in diet and medication.
The CHOC Surgical Neonatal Intensive Care Unit (NICU)
If your baby requires a surgery to repair an intestinal atresia, they may be cared for in the CHOC Surgical Neonatal Intensive Care Unit (NICU), one of only two Surgical NICUs of its kind in the nation and part of CHOC’s Level 4 NICU. The CHOC Surgical NICU operates with a coordinated treatment protocol that has been shown to result in fewer patient complications, better outcomes and faster discharges.
The Fetal Care Center of Southern California
If an abnormality is detected before your baby is born, our team of pediatric experts at the Fetal Care Center of Southern California can confirm your baby’s diagnosis, provide extensive condition education and counseling, and begin comprehensive treatment planning for after your baby’s birth.