Differential diagnosis of gastrointestinal atresia

Approach to differential diagnosis of gastrointestinal atresia:

  • Failure to pass a nasogastric tube is due to esophageal atresia
  • A double bubble sign on AXR is nearly always due to duodenal atresia
  • Several dilated loops of jejunum – a triple bubble sign – without distal gas should be due to jejunal atresia which can be confirmed by an upper GI exam
  • Ileal atresia has a microcolon on enema without meconium pellets, and the terminal ileum cannot be refluxed
  • Colonic atresia has a microcolon on enema that is shortened in length
  • In anorectal malformation an enema cannot be done