Intestinal Atresia

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What is intestinal atresia?

Intestinal atresia (IA) happens when part of your child’s bowel (intestine) does not form correctly before they are born. It is pronounced in-TESS-ti-nul uh-TREE-zhuh.

IA is present at birth (congenital). In babies with IA, the bowel is closed off in 1 or more places, instead of being an open tube. Some children are missing parts of the bowel between the closed spots.

Your child may have just a small blockage, or they may be missing large parts of their bowel. IA prevents food and poop (stool) from moving through your child’s body. It is most common in the small bowel. But it also can affect the large bowel.

Types of IA
Doctors sometimes describe IA by naming the part of the bowel it affects. IA can be in:
- The first part of the small bowel, called the duodenum (pronounced doo-ODD-en-um)
- The middle part of the small bowel, called the jejunum (pronounced jeh-JOON-um)
- The last part of the small bowel, called the ileum (pronounced ILL-ee-um)
- The large bowel, called the colon
IA in the duodenum (duodenal atresia) is due to a problem with how the first part of the small bowel forms before birth. Babies with this condition may have other health problems at birth, such as Down syndrome and heart problems. This type is most often diagnosed during pregnancy.

IA in other parts of the bowel is most often caused by poor blood supply to that area before birth.

Pediatric General and Thoracic Surgery at Seattle Children's

When it comes to your child’s health, experience matters. Our surgical teams have the skills to do it right the first time and to care for children with the rarest conditions.

Symptoms of Intestinal Atresia

Before birth

An ultrasound during pregnancy may show that your baby has intestinal atresia. One sign of IA is extra amniotic fluid inside the mother’s womb. This is called polyhydramnios (pronounced pahl-ee-hi-DRAM-nee-us). It happens because the baby’s bowel does not absorb normal amounts of amniotic fluid.
After birth
Within 1 to 2 days after birth, babies with IA may have 1 or more of these symptoms:
- No stool passed (bowel movement)
- Swollen belly from gas
- Vomit that may be yellow or greenish in color
- Not wanting to eat

Diagnosing Intestinal Atresia

If an ultrasound during pregnancy shows your baby may have IA, our Fetal Care and Treatment Center can work with you to plan for treatment your baby will need.

If your baby has symptoms after they are born, the doctor will do imaging studies. Your baby may have:

A regular X-ray of the belly. X-rays may show signs of IA, such as bubbles of fluid and air in the stomach and first part of the bowel or no air in other parts of the bowel.
A series of X-rays called a contrast study. In contrast studies, doctors put a liquid that contains a dye into your baby’s large bowel or stomach. The dye helps your baby’s bowel show up on X-ray. Sometimes a baby drinks the liquid. Sometimes doctors give the liquid through a feeding tube placed into the baby’s stomach. Sometimes doctors give the liquid through a small tube placed in the baby’s rectum.

If your baby has duodenal atresia, the doctor will check your baby for other problems, such as heart defects and chromosome abnormalities.

Treating Intestinal Atresia

Intestinal atresia (IA) is treated with surgery in the first days of life. Before surgery, your baby’s doctors will:

Stabilize your baby’s health.
Insert a tube through your baby’s nose and mouth into their stomach (called a nasogastric tube or NG tube). The tube empties the stomach and keeps gas out.
Give your baby fluids by placing an intravenous (IV) line into a vein.

Surgery for Intestinal Atresia

Your child’s surgeon will talk with you about the best type of surgery for your child:

Open surgery, using 1 larger cut (incision) in your child’s belly.
Laparoscopic surgery using 3 or 4 tiny cuts. The doctor inserts a tube into your child’s belly. The tube holds a small camera to see the bowel and tools do the surgery.

During surgery
At the time of surgery, we will give your child medicine (general anesthesia) to make them sleep without pain. The doctors at Seattle Children’s who give your child anesthesia are board certified, with extra years of training in how to give pain medicine to children safely.

After making the cut in your child’s belly, the surgeon:
- Checks the bowel to find the parts that are blocked.
- Cuts on both sides of the blocked sections to make openings. This allows the bowel to become an open tube.
- Connects the parts of the bowel with stitches.
- Sometimes has to remove parts of the bowel to correct the problem.
- Sews closed the opening in the belly wall.
How long the surgery takes depends on how much of the bowel is affected.
After surgery
After surgery, the team in our Level IV Neonatal Intensive Care Unit (NICU) will care for your baby.

We will give your child:
- Pain medicine for comfort
- Fluids and antibiotics through an IV tube in their vein
When your baby is ready, they move to a regular hospital room.
Nutrition and feeding
Sometimes it takes several weeks or longer for your child’s bowel to heal enough so they can eat by mouth. Until then, your child will get nutrition through 1 or more of these:
- A special tube that goes into a large vein. This is called a PICC line or peripherally inserted central catheter.
- A feeding tube that passes into their stomach through their nose (nasogastric tube or NG tube).
- A feeding tube through an opening in your child’s belly wall. After making the opening, the surgeon gently puts in a G tube or a device called a gastrostomy button. This is less common.
How long your child will need any of these devices depends on how their bowel heals after surgery. With a G tube or NG tube, your baby can still eat by mouth if they are able and, as needed, receive breast milk or formula through the feeding tube.

Our nurses and lactation specialists will do all that we can to support you in providing breastmilk for your baby. To keep your milk flowing and to build a milk supply for your baby, we help you with breast pumping and storing your milk. When your baby is ready, our nurses and feeding therapists help with the transition to feeding by bottle or breast.

Our nutritionists keep a careful watch on your baby to be sure they are growing well.
Going home

Your baby will stay in the hospital until they can feed well, poop normally and gain enough weight. Most children will stay in the hospital for 3 to 4 weeks. Some children stay longer, especially if they have other health problems.

By the time your baby leaves the hospital, their incision will be well healed. There are usually no restrictions on activity or bathing.

When your baby is ready to go home, they may still need medicine or a feeding tube in their nose for part of their nutrition. Our nurses will help set up the supplies and equipment you need. You will have plenty of time to practice all your baby’s care before going home. Most babies will be able to get all their feedings by mouth within a few months.
Follow-up care
About 2 weeks after going home from the hospital, your child will see the surgeon and a dietitian for a follow-up visit. They will check to make sure:
- Your child is feeding well and gaining weight.
- The incision has healed.
- There are no other health issues.
If feeding by mouth is hard for your child, our occupational therapists can help. Other follow-up visits depend on your child’s health.