Duodenal atresia differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

Duodenal atresia must be differentiated from other diseases that cause persistent vomiting, and feeding difficulties, such as volvulus, jejuno-ileal atresia, malrotation, and meconium ileus. It is differentiated based on imaging.

Duodenal atresia must be differentiated from other diseases that cause persistent vomiting, and feeding difficulties, such as volvulus, jejuno-ileal atresia, and malrotation.^[1]^[2]^[3]

Diseases	History and Symptoms				Physical Examination			Laboratory Findings			Other Findings
Diseases	Vomiting	Feeding difficulty	Stool present	Bilious vomitus	Abdominal distension	Abdominal tenderness	Dehydrated	Abdominal ultrasound	Abdominal x-ray	Electrolytes	Other Findings
Duodenal Atresia	+	+	+/-	+	+/-	+	+	Gas in stomach with absent gas in small intestine	Stomach distension and air fluid levels Double bubble sign	Hypokalemia Hyperchloremia	Down syndrome
Jejuno-ileal atresia	+	+	+/-	+	+	+	+	Gas in stomach with no gas in colon	Stomach and proximal small intestine distension	Hypokalemia Hyperchloremia
Volvulus	+	+	+/-	+	+	+	+	Spiral sign	Malrotation of intestine with gas in stomach and air fluid levels	Hypokalemia Hyperchloremia
Meconium ileus	+	+	+/-	+	+	+	+	Distension	Air fluid levels	Hypokalemia Hyperchloremia	Cystic fibrosis

↑ Adams, Stephen D.; Stanton, Michael P. (2014). "Malrotation and intestinal atresias". Early Human Development. 90 (12): 921–925. doi:10.1016/j.earlhumdev.2014.09.017. ISSN 0378-3782.
↑ Morris, Grant; Kennedy, Alfred; Cochran, William (2016). "Small Bowel Congenital Anomalies: a Review and Update". Current Gastroenterology Reports. 18 (4). doi:10.1007/s11894-016-0490-4. ISSN 1522-8037.
↑ Kimura K, Loening-Baucke V (2000). "Bilious vomiting in the newborn: rapid diagnosis of intestinal obstruction". Am Fam Physician. 61 (9): 2791–8. PMID 10821158.