Intestinal atresia or obstruction and esophageal atresia

Learning that your baby has atresia is troubling. Our specialists at the Center for Fetal Care make sure that your baby stays safe in the womb. Surgeons then make effective repairs after birth. Throughout care, we partner as needed with top specialists in other fields at Advocate Children’s Hospital.

Learn more about what to expect when you come to us for your baby’s care.

What is atresia?

Atresia is a congenital condition (present at birth) that affects the digestive tract, which runs from the mouth through the esophagus, stomach, and intestines to the rectum and anus. When it happens, a part of the digestive tract ends abnormally which causes blockages in various parts of the digestive tract and prevents nutrients from flowing properly.

Atresia occurs when parts of the digestive tract don’t develop properly in the womb. Atresia can develop in the esophagus or in various sections of the intestines, including the:

• Duodenum, the upper part of the small intestine that connects to the stomach
• Jejunum, middle part of the small intestine
• Ileum, end of the small intestine
• Colon, the large intestine

Types of atresia

The types of atresia include:

• Esophageal: The esophagus carries food and liquids from the mouth to the stomach. In most types of esophageal atresia, the upper esophagus ends and doesn’t connect with the lower esophagus. In some cases, the esophagus is narrowed. Many babies with esophageal atresia also have a tracheoesophageal fistula, an abnormal opening between the esophagus and the trachea (windpipe). The fistula causes anything that your baby swallows to go into their lungs instead of into the rest of their digestive tract.
• Duodenal: The duodenum is narrowed or missing a segment. Duodenal atresia often occurs in babies with Down syndrome, a genetic disorder involving an extra copy of a chromosome. We partner with the Down syndrome clinic at Advocate Children’s Hospital to help your baby.
• Intestinal: Intestinal atresia has several types, with areas narrowed or completely missing.

What causes atresia?

The causes of atresia are unknown. Research suggests that risk factors may include genetic changes or certain medications taken during pregnancy.

Atresia symptoms and signs

A routine ultrasound can show some signs of atresia during pregnancy, and other signs occur after a baby is born.

Signs that can appear during ultrasounds of babies in the womb include:

• Distended (bloated) intestine
• Distended stomach (with duodenal atresia)
• Too much amniotic fluid (protective fluid surrounding the baby in the womb)

Atresia diagnosis

If your doctor suspects atresia based on a routine ultrasound, you may need imaging that offers more details and can confirm a diagnosis. The imaging we may use includes:

• Targeted, high-resolution ultrasound
• Ultrafast fetal MRI
• X-ray

We also refer you to our genetics program for a consultation and evaluation. We gather as much information as possible to plan for the rest of your pregnancy, your baby’s delivery and care after birth. Learn more about how we diagnose fetal conditions.

Evaluation for related conditions

Some children with atresia may also have problems with their heart, and those with duodenal atresia may have Down syndrome. We partner with the Heart Institute and the Down syndrome clinic at Advocate Children’s Hospital for additional care.

Additional tests for these children may include:

• Fetal echocardiogram: We take a noninvasive ultrasound of the baby’s heart to check for structural problems.
• Amniocentesis: We use a needle to take fluid from the amniotic sac (protective membrane surrounding your baby) to evaluate for chromosome problems.
• Chorionic villus sampling (CVS): We take a small tissue sample from the placenta to test for signs of Down syndrome. We perform CVS with ultrasound guidance, using a narrow needle or a thin tube.

Atresia treatment

We closely monitor you and your baby for problems that could lead to premature birth, such as a buildup of amniotic fluid. This buildup enlarges the uterus and creates pressure, which can lead to preterm labor. If necessary, we may perform an amnioreduction, which uses a small needle inserted through the abdomen to remove excess fluid and relieve pressure.

Care after birth

The neonatology and pediatric surgery teams evaluate your baby after birth. They will determine next steps in care, which may include surgery to repair the atresia or blockages.