Intestinal Atresia

Overview

Intestinal atresia means a baby is born with a section of the bowel (intestine) that is missing, closed off, or not joined up. Because the tube is not open, milk and digestive juices cannot move through. It is a birth defect, not an illness caught later, and it almost always shows up in the first day or two of life. Doctors usually need to do an operation to join the bowel back together or to make a way through.

It is uncommon. Overall, roughly 1 in every 2,000 to 3,000 babies is born with some type of intestinal atresia. Some types are more common than others, and rates vary between countries.

It affects newborn babies. Many cases are spotted before birth on a routine pregnancy ultrasound. Some babies with intestinal atresia also have other conditions, such as Down syndrome or other differences in how organs formed, and some are born early or at a low birth weight.

Symptoms

Common symptoms

• Vomiting that is green or yellow-green (bile-stained) — this is a warning sign in a newborn
• A swollen, tight or tender tummy
• Not passing the first poo (meconium) within the first day or two
• Refusing feeds, or vomiting after every feed
• Fewer wet nappies, sunken soft spot, or other signs of dehydration
• Yellowing of the skin or eyes (jaundice)
• Lethargy, poor feeding, or a baby who is hard to wake

Symptoms in children

• In newborns and infants, the signs above are the main ones — green vomiting plus a swollen tummy is the classic pattern.
• Some babies are found before any symptoms appear, because a pregnancy ultrasound showed extra fluid or a dilated bowel loop.
• Children who have had surgery may later have reflux, constipation, looser stools, slower weight gain, or short-term feeding difficulties.
• Rarely, a child can develop a narrowed or blocked section later because of scar tissue; this can cause vomiting and tummy pain and needs prompt review.

Symptoms in older adults

• Intestinal atresia is a condition babies are born with, so it is not something that develops for the first time in adults.
• Very rarely, an adult can develop a blocked or narrowed bowel from scarring after surgery, inflammation, radiotherapy, or other causes — but this is a different problem from congenital atresia.
• Any adult with persistent vomiting, a swollen belly, severe tummy pain, or no bowel movement passing should be assessed urgently.

Causes

Main causes

• The bowel not forming properly during the early weeks of pregnancy, when the intestine is still developing as a tube.
• A problem with the blood supply to part of the bowel while the baby is in the womb, which can leave a gap or a narrowed section (this is the usual cause for atresia in the small bowel).
• Sometimes a genetic or chromosomal condition plays a part, and some babies have more than one area affected.
• Most cases happen without any clear reason, and parents have usually done nothing to cause it.

Risk factors

• A family history of intestinal atresia or other bowel birth defects
• Certain genetic or chromosomal conditions, such as Down syndrome
• Too much fluid around the baby in the womb (called polyhydramnios), which can be a sign of a blockage
• Being born early or having a low birth weight
• Being one of twins or part of a multiple pregnancy
• Having other organs that formed differently — sometimes these are linked

When to see a doctor

See a doctor urgently if:

• Your newborn vomits green or yellow-green fluid
• Your baby has not passed the first poo and is feeding poorly or has a swollen tummy
• Your baby is vomiting repeatedly and seems dehydrated or sleepy
• A pregnancy scan has shown extra fluid or a dilated bowel loop — contact your maternity team the same day
• Your child has a swollen belly with vomiting and stops passing wind or stool

Book a routine appointment if:

• You have questions about a scan result or a family history of bowel problems
• You are planning a pregnancy and want to talk about inherited conditions in your family
• After surgery: follow-up appointments about feeding, growth, bowel habits, and the scar
• Your child is growing more slowly than expected or has ongoing feeding or stool problems

Diagnosis

Intestinal atresia is usually found either on a routine pregnancy ultrasound or very soon after birth when a baby shows the classic signs — green vomiting, a swollen tummy, and no first poo. Doctors then use imaging to see exactly where the bowel is blocked, and they check the baby's fluids and salts at the same time, because vomiting can cause dehydration.

Tests that may be done

• Pregnancy ultrasound, which may show too much fluid around the baby or a widened loop of bowel
• An X-ray of the baby's tummy, which can show a blockage pattern and where it is
• A special X-ray using a small amount of contrast dye (a liquid that shows up on scans) to see the shape of the bowel
• Ultrasound of the tummy
• Blood tests to check hydration, salt levels, and general health
• Checks for other conditions that can come alongside atresia, such as heart or kidney problems, and sometimes genetic testing

What to expect at your appointment

Your baby will be looked after in a newborn or specialist baby unit. They will not be fed by mouth at first, and a thin tube through the nose into the stomach will drain away fluid so the tummy is not stretched. Fluids and nutrition go through a drip into a vein. The team will explain the scan results and plan surgery, usually within a day or two. You will be told what is happening at each stage, and you should feel free to ask questions or ask for an interpreter if that helps.

Treatment

The main treatment is an operation to open up or join the blocked section of bowel. Before surgery, the baby is kept safe with fluids through a drip, a tube to drain the stomach, and close monitoring. Most babies need a stay in a newborn intensive care unit until they are feeding and growing well.

Self-care at home

• Follow the feeding plan your baby's team gives you — small, frequent feeds and slow increases are common at first
• Keep the operation scar clean and dry, and ask the team before using any creams or powders on it
• Keep a simple record of feeds, wet nappies, and poos so you can spot changes early
• Wash your hands well before handling your baby, especially in the first weeks after surgery
• Keep follow-up appointments for growth checks and bowel reviews, even when your child seems well
• Ask for help with nights and feeding — recovering at home is tiring for parents too

Medical treatments

Before and after surgery, babies are supported with fluids and nutrition given through a vein or a feeding tube, a tube to drain the stomach, and medicines to prevent or treat infection and to manage pain. Vitamin and mineral supplements may be suggested if feeding is limited for a while. Feeding is built up slowly, and some babies need special formula or breast milk fortification for a time. Your baby's team will explain each step, and your pharmacist or nurse can tell you what each medicine is for.

When is surgery considered?

Surgery is almost always needed, and it is usually done within the first few days of life once the baby is stable. The surgeon either joins the two ends of bowel together or, if the ends cannot be safely joined straight away, brings one end out through the skin (a stoma) and joins things back later in a second operation. Some babies need more than one operation. The timing depends on your baby's weight, general health, and the type of atresia.

Living with this condition

After recovery, most children live full, active lives. Early weeks at home often involve frequent feeds, growth checks, and a bit of trial and error with feeding. Some children have looser stools or constipation and need a bit more attention to their bowels. A small number have longer-term issues with absorbing nutrients and need ongoing specialist care.

Lifestyle tips

• Keep a flexible routine around feeds and rest — babies who have had bowel surgery often tire more easily at first
• Attend growth and development checks so any slowdown is picked up early
• Encourage normal play and activity as your child grows — there is usually no need to hold them back
• Tell your child's nursery, school, or childminder about the surgery, and who to contact if there is a problem
• Carry any emergency information your team gives you, and know the plan if your child becomes unwell
• As your child grows, talk to them about their scar and their health in simple, calm words

Diet and exercise

Feeding plans are individual. Many babies do well on breast milk or standard formula once feeding is established, while some need a special formula, extra calories, or vitamin and mineral supplements for a while. As children grow, a normal balanced diet is usually fine, but your dietitian can advise if absorption is a concern. There is no special exercise plan — normal playing, running, and swimming are encouraged once the wound has healed and your team is happy.

Mental health and emotional wellbeing

It is very common for parents to feel shocked, frightened, or guilty when their newborn needs surgery, and to feel anxious for a long time afterwards. Some parents have upsetting memories of the intensive care stay, or feel low or on edge after coming home. These feelings are normal and treatable. Talk to your baby's team, your own doctor, or a health visitor — asking for support is a sign of strength, not weakness. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line straight away.

Prevention

Intestinal atresia cannot be prevented, and nothing a parent did or did not do causes it. What does help is good antenatal care: regular pregnancy check-ups and ultrasound scans mean a blockage can be spotted before birth, so the right team can be ready when your baby arrives. If you have a family history of bowel or chromosomal conditions, a genetic counsellor can talk through what this might mean for a future pregnancy.

Screening programmes

There is no separate screening test for intestinal atresia. It is sometimes noticed on routine pregnancy ultrasound, especially the mid-pregnancy scan, which is one of the reasons attending your scan appointments matters.

Complications

If left untreated

• Severe dehydration and salt imbalances from repeated vomiting
• Malnutrition and poor growth, because milk cannot reach the part of the bowel that absorbs food
• Infection in the bowel or the tummy lining
• A split or hole in the bowel wall, which is a medical emergency
• Breathing difficulty from a very swollen tummy pressing on the lungs
• In the most serious cases, a life-threatening situation — which is why prompt treatment matters so much

Long-term outlook

The outlook is good for most babies. With timely surgery and good newborn care, the large majority survive and go on to live normal lives. Some children need follow-up for feeding, growth, or bowel habits, and a small number have longer-term digestive problems that need specialist support. Your baby's team can tell you what to expect for your child's particular type of atresia — and it is fine to ask them to repeat or explain anything.

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