Duodenal Obstruction (Atresia or Web)

Duodenal obstruction is a congenital condition where the first part of the small intestine (the duodenum) is narrowed or blocked, preventing the normal passage of food and fluids from the stomach to the intestines. Two common causes of this obstruction are duodenal atresia and duodenal web.

Duodenal atresia is a complete blockage of the duodenum, while a duodenal web is a thin membrane of tissue that partially or fully obstructs the lumen. Both conditions are present at birth and require surgical correction. These anomalies often occur alongside other congenital conditions, such as Down syndrome or cardiac defects.

Causes and Associations

Duodenal atresia and web form during fetal development when the duodenum fails to recanalize properly. Although the exact cause is not always known, these abnormalities are frequently associated with:

  • Down syndrome (Trisomy 21)
  • Congenital heart disease
  • Malrotation of the intestine
  • Other gastrointestinal anomalies

Signs and Symptoms

Symptoms of duodenal obstruction usually present in the first days of life. Classic signs include:

  • Bilious (green) vomiting shortly after birth
  • Abdominal distension, especially in the upper abdomen
  • Failure to tolerate oral feeds
  • Minimal or no stool passage

In less severe cases, such as a partial obstruction from a duodenal web, symptoms may appear later in infancy or childhood with intermittent vomiting, feeding difficulties, or poor weight gain.

Diagnosis

Diagnosis typically involves imaging studies, including:

  • Abdominal X-ray showing the classic “double bubble” sign (air in the stomach and proximal duodenum with no air beyond)
  • Upper GI series for more detailed visualization of the obstruction
  • Ultrasound or echocardiogram to check for associated anomalies

Early diagnosis is essential to plan timely surgical intervention and supportive care.

Treatment

Treatment for duodenal obstruction is surgical and may involve:

  • Duodenoduodenostomy – creating a bypass around the blocked segment
  • Resection of a duodenal web if present
  • Evaluation for additional anomalies or malrotation

Before surgery, newborns receive IV fluids, gastric decompression through a nasogastric tube, and monitoring in a neonatal intensive care setting. Recovery after surgery typically includes gradual introduction of feeds and close follow-up to ensure normal growth and development.

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Frequently Asked Questions

Duodenal atresia is a complete blockage of the duodenum, while a duodenal web is a thin membrane that may cause a partial or complete obstruction.

Most cases are diagnosed shortly after birth due to symptoms like bilious vomiting and feeding intolerance, though partial obstructions may be diagnosed later in infancy or childhood.

It develops during fetal development, often without a known cause, and may be associated with other congenital anomalies such as Down syndrome or heart defects.

Yes, duodenal obstruction requires surgical correction to restore normal digestive function and prevent complications from feeding difficulties or intestinal blockage.