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Hidden challenges in embryonic development: the causes and wonderful hypotheses behind Doudna's atresia!
Doudna atresia is a congenital disorder in which part of the duodenal lumen is missing or completely closed. This condition can cause an increase in amniotic fluid (polyhydramnios) during pregnancy and intestinal blockage in newborns. According to clinical reports, infants usually experience bilious or nonbilious vomiting after the first oral feed within 24 to 48 hours of life, the severity of which depends on the location of the obstruction. Imaging examinations showed that the baby's stomach and duodenum close to the pyloric opening were swollen, forming a feature medically known as the "double bubble sign."
Treatment for Doudna atresia involves aspirating the trapped fluid via a nasogastric tube and providing necessary fluids intravenously, while surgically repairing the closure of the intestine.
Symptoms and Signs
During pregnancy, Doudna atresia is associated with an increase in amniotic fluid in the uterus, known as polyhydramnios. The reason for this phenomenon is that the fetus is unable to swallow the amniotic fluid and absorb it through the digestive tract. After birth, babies may have a bloated abdomen, especially in the upper abdomen. Vomiting is common in babies who are etched to the first day.
Diagnosis
Imaging examination
Antenatal check-up
Prenatal ultrasound examination can identify and diagnose Doudna's atresia early. If the stomach is not filled with fluid during imaging studies, this may indicate the presence of Doudna's atresia. We found that early diagnosis helps in providing antenatal counseling and preparing for postnatal management.
Postnatal examination
The diagnosis of Doudna's atresia is usually confirmed by radiographic testing. An X-ray of the abdomen is the first step in the evaluation and this needs to be done after a nasogastric tube has been placed. The two bubbles shown on the X-ray represent air in the stomach and proximal duodenum separated by the pyloric sphincter, forming the so-called "double bubble" sign.
Although the double bubble sign is often viewed as pathological, it is not specific and may indicate other pathological conditions such as annular pancreas or small bowel volvulus.
Reason
Currently, the exact cause of Doudna's locked-in syndrome is unknown. In 1900, the famous physician Julius Tendler proposed that the cause of Doudna's atresia might be the result of obstruction of the intestinal lumen and its failure to reopen during embryonic development. In recent years, research focus has shifted to the fibroblast growth factor pathway in mouse models because Tendler's original hypothesis failed to explain the different types of Doudna atresia.
TreatmentEarly treatment of Doudna's atresia involves draining the stomach through a nasogastric tube and giving intravenous fluids. Definitive treatment of Doudna atresia requires surgery (inter-enterostomy), which can be performed using either open or laparoscopic techniques. Surgery is usually not immediately urgent, and a delay of 24 to 48 hours to facilitate transport and further evaluation is possible.
Complications and epidemiology
Although the prognosis is generally good, the risk of complications increases with the presence of severe congenital anomalies. Complications of surgical repair may include peptic ulcer, gastroesophageal reflux disease, cholecystitis, etc. Epidemiological data on Doudna atresia show that it affects 1 in every 10,000 live births and is the most common form of intestinal atresia, accounting for as much as 60% of all intestinal atresia cases.
Are these treatment and management strategies sufficient to ensure that every person with Doudna's locked-in syndrome receives timely and appropriate care?
