Duodenal atresia is a condition in which the beginning of the small bowel (duodenum), which begins right after the stomach, has not developed properly. The duodenum is not open, and the stomach contents cannot pass through it.

No one knows why this happens. Some doctors think it occurs while the baby is in the womb and that there is a loss of blood supply to this area in the developing baby. It occurs in approximately one out of 6,000 newborns, and about 25 percent of duodenal atresia is found in children with Down syndrome.

Babies born with this condition begin vomiting large amounts of material right after birth. The vomit may be green and often is much more than was fed to the infant. One or two initial meconium stools (the first stools of newborns) may be passed, but no further bowel movements occur after that. Without treatment, these babies get very sick very quickly.

Before birth, duodenal atresia can be seen in the mother on ultrasound. After birth, doctors may order an X-ray if the condition is suspected.

Surgery is necessary to fix the problem. With the baby under general anesthesia, the surgeon removes the blocked section of duodenum. An incision is made in the abdomen, and the remaining healthy ends of the bowel are reattached. A gastrostomy tube (G-tube) is inserted into the stomach and comes out through the skin to give the stomach a rest. The incision then is closed.

About 24 hours after surgery, the baby will be started on clear liquids and then formula, as tolerated. These babies usually have problems absorbing fluid and eating and will need lots of patience and encouragement. Vomiting one or two times after surgery is not unusual and should resolve. Many babies require regular B-12 injections after surgery to help them absorb this nutrient.

For an appointment with a Washington University pediatric surgeon, call (314) 454-6022, Monday-Friday, 8 a.m.-5 p.m.