Digestive and Gastrointestinal Conditions

Intestinal Atresia

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.

  • 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.

Intestinal Atresia at Seattle Children’s

We have treated many hundreds of children with IA. Our surgeons are very experienced at repairing the bowel so your baby can thrive.

Contact our Pediatric General and Thoracic Surgery Department at 206-987-2794 for an appointment, second opinion or more information.

    • Sometimes care starts before birth if an ultrasound during pregnancy shows your baby has IA. The team at our Prenatal Diagnosis and Treatment program can work with you to get ready for your baby’s birth and the treatment they will need early in life.
    • We coordinate carefully with your birth hospital so your baby gets special care when they are born and as they travel by ambulance to Seattle Children’s.
    • Our transport team of physicians, nurses and respiratory therapists are national leaders in safely moving fragile newborns.
    • Each year, we care for 20 to 30 babies with IA. Your healthcare team will include specialists in newborn care (neonatologists), pediatric surgery, nutrition, the digestive system (gastroenterologists) and lactation support.
    • Our surgery team is experienced in performing the procedures to repair your baby’s bowel. We are skilled at treating other bowel problems that sometimes affect babies with IA, such as gastroschisis.
    • Seattle Children’s has the state’s first Level IV Neonatal Intensive Care Unit (NICU), the highest level of care. We are skilled and equipped to care for the sickest newborns.
    • Some babies with IA have other health problems at birth. We have all the experts your family needs. Seattle Children’s ranks among the best in all 10 pediatric specialties rated by U.S. News & World Report in 2018. We are the only hospital in the Northwest to do so.
    • Your newborn needs care designed just for them. Babies differ from adults in how they react to illness, pain, medicine and surgery. That is why our surgeons are all board certified in pediatric surgery.
    • We do only the tests, radiation and surgery that your child needs. We use lower radiation doses than recommended by the American College of Radiology.
    • Seattle Children’s is 1 of just 5 hospitals in the nation recognized by ChildKind International for how well we prevent and treat pain in children.
    • At Seattle Children’s, you have a full team behind you before, during and after surgery. We work together to meet all your child’s health needs.
    • Having a baby born with IA can be scary. We take time to explain your child’s condition and help you fully understand your treatment options.
    • Our doctors, nurses, child life specialists and social workers help your family through the challenges of IA. We connect you to community resources and support groups.
    • We work with many children and families from around the Northwest and beyond. We can help with financial counseling, schooling for kids in the family, housing, transportation, interpreter services and spiritual care. Learn about our services for patients and families.
  • Seattle Children’s leads research in the lab and in the clinic to improve treatment and quality of life for children born with IA.

    • Our Intestinal Rehabilitation Program does research on the most severe types of IA to help prevent problems like short bowel syndrome.
    • Our newborn specialists are leaders in research to improve outcomes for babies born with complex problems. See Pushing Limits, Saving Lives.
    • We work to find the safest, most effective ways to reduce stress in the NICU and to ease pain. Learn more about Seattle Children’s neonatology research.
    • Our patients have the option to take part in research studies of promising new treatments. These are called clinical trials.

Symptoms of Intestinal Atresia

  • 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. 

  • 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 Prenatal Diagnosis and Treatment team 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.
  • 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, 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.

  • 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.

  • 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.

  • 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.

Contact Us

Contact our Pediatric General and Thoracic Surgery Department at 206-987-2794 for an appointment, second opinion or more information.

To make an appointment, you can call us directly or ask your child’s primary care provider to refer you. We encourage you to coordinate with your primary care provider when coming to Seattle Children’s.

We have clinics in Bellevue, Everett, Federal Way, Seattle and Tri-Cities.

Providers, see how to refer a patient.