Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients Caregivers Providers
Log In Ask a Question
PubMed This is a summary of 21 peer-reviewed journal articles Updated
Neonatology

The NICU Journey and Surgery for Small Bowel Atresia

At a Glance

Babies born with small bowel atresia require surgery to remove or bypass the intestinal blockage. Care involves pre-surgery stabilization in the NICU, the surgical repair, and a gradual recovery period using IV nutrition (TPN) until the bowel heals and can digest milk.

The journey from a diagnosis to the operating room is a whirlwind for parents. Whether you learned of the blockage during a routine ultrasound or discovered it shortly after birth, your baby is now in the Neonatal Intensive Care Unit (NICU), a specialized environment designed to support them before, during, and after surgery [1][2].

It is important to set realistic expectations for your NICU stay: depending on the complexity of the atresia, your baby might be in the hospital anywhere from a few weeks for a simple duodenal repair to several months for complex jejunoileal atresias [2][3].

Before the Diagnosis: The “Double Bubble”

Many parents first hear about a potential problem during a prenatal ultrasound. A common finding for duodenal atresia is the double bubble sign [4].

  • What it is: This sign occurs when the baby’s stomach and the first part of the duodenum both fill with fluid, appearing as two dark circles (“bubbles”) on the scan [4][5].
  • Why it happens: Because the fluid cannot pass through the blockage, it backs up and stretches these two areas [6].
  • Polyhydramnios: This often leads to an excess of amniotic fluid (polyhydramnios) because the baby cannot swallow and process the fluid normally [7][8].

Stabilization: Preparing for Surgery

Before the surgeon can repair the blockage, the medical team must stabilize the baby. This “pre-op” phase is focused on safety and comfort [1].

  • Decompression: A small tube (called an NG tube or OG tube) is passed through the nose or mouth into the stomach to drain excess fluid and air [9][10]. This prevents vomiting and protects the baby’s lungs from accidental aspiration [11].
  • IV Fluids and TPN: Since the baby cannot eat, they receive fluids and essential nutrients through an IV. This is called Total Parenteral Nutrition (TPN), which provides the proteins, fats, and sugars needed for growth and healing [12][3].
  • A Note for Mothers: Because your baby will not be allowed to eat by mouth (NPO) for some time, ask to see a NICU lactation consultant immediately to learn how to pump and safely store your breastmilk for when your baby is ready.

The Surgical Repair

The goal of surgery is to bypass or remove the blockage and connect the healthy segments of the bowel. This connection is called an anastomosis [13].

Surgery for Duodenal Atresia

The standard repair is a duodenoduodenostomy (specifically the Kimura “diamond-shaped” repair) [13]. The surgeon makes a small opening in both sections of the duodenum and sews them together in a way that creates a wide, reliable path for food [14].

Surgery for Jejunoileal Atresia

For blockages further down the small intestine, the approach depends on how the bowel looks:

  • Primary Anastomosis: If the two ends are healthy and close in size, they are sewn directly together [15].
  • Tapering Enteroplasty: If the section above the blockage is very stretched out (dilated), the surgeon may narrow it (“taper” it) so it can better push food through the new connection [16].
  • Bishop-Koop Stoma: In complex cases (like Type IIIb or IV), the surgeon may create a temporary stoma [17][18]. This means a small piece of the bowel is brought through an opening on the baby’s belly. Stool empties into a specialized pouch (ostomy bag). If your baby needs a stoma, do not panic—NICU nurses will thoroughly train you on exactly how to empty, clean, and manage the bag before you ever go home.

Laparoscopic vs. Open Surgery

Depending on the baby’s size and the complexity of the atresia, the surgeon may use a laparoscopic (minimally invasive) approach with tiny cameras and instruments, or an open approach (laparotomy) [19]. Both methods are safe and effective, though laparoscopic surgery may sometimes lead to a slightly shorter hospital stay [19][20].

The Road to Recovery

After surgery, the bowel needs time to “wake up” and start moving again. This temporary pause in movement is called postoperative ileus [3].

Your baby will remain on TPN for several days or even weeks while the medical team waits for signs that the gut is working, such as bowel movements (or output in the stoma bag) and decreased drainage from the NG tube [21][3]. Once the “green light” is given, the team will start enteral feeds (milk or formula) in very small amounts, slowly increasing them as the baby proves they can tolerate the food [3][2]. Progress can be slow, but each small step forward is a victory in the NICU.

Common questions in this guide

Why does my baby need an NG tube before small bowel atresia surgery?
An NG or OG tube is used to drain excess fluid and air from your baby's stomach. This process, called decompression, keeps your baby comfortable and prevents vomiting that could lead to fluid entering their lungs.
What is a duodenoduodenostomy?
A duodenoduodenostomy is the standard surgical repair for duodenal atresia. The surgeon creates a wide, functional connection between the two healthy sections of the intestine to bypass the blockage.
Will my baby need a stoma bag after bowel surgery?
In some complex cases, the surgeon may need to create a temporary stoma to allow the bowel to heal. If this happens, your NICU team will teach you exactly how to safely empty and clean the ostomy bag before you take your baby home.
How will my baby get nutrition while recovering in the NICU?
After surgery, your baby will receive Total Parenteral Nutrition (TPN) through an IV while their bowel rests and heals. Once their digestive system wakes up and starts working again, the medical team will slowly introduce milk or formula.
What does the double bubble sign mean on my prenatal ultrasound?
The double bubble sign appears when fluid backs up in a baby's stomach and the first part of the small intestine due to a blockage. It is a very common prenatal indicator of duodenal atresia seen on ultrasounds.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Was the surgery performed laparoscopically or through an open incision?
  2. 2.Did you perform a primary anastomosis or create a stoma like a Bishop-Koop?
  3. 3.Was a 'tapering enteroplasty' needed to narrow the dilated part of the bowel?
  4. 4.What specific signs of bowel function (peristalsis) are we waiting for before starting feeds?
  5. 5.How will my baby receive nutrition (TPN) while we wait for the gut to wake up?
  6. 6.Is there a specific plan for how we will transition from TPN to milk or formula?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (21)
  1. 1

    Neonatal Intestinal Obstruction: A 15 Year Experience in a Tertiary Care Hospital.

    Verma A, Rattan KN, Yadav R

    Journal of clinical and diagnostic research : JCDR 2016; (10(2)):SC10-3 doi:10.7860/JCDR/2016/17204.7268.

    PMID: 27042546
  2. 2

    Does Preterm Status Hinder the Timely Diagnosis of Intestinal Atresia?

    Tolaymat Y, Irons R, Taylor JA, et al.

    NeoReviews 2023; (24(5)):e300-e305 doi:10.1542/neo.24-5-e300.

    PMID: 37122053
  3. 3

    Intestinal Atresias.

    Rich BS, Bornstein E, Dolgin SE

    Pediatrics in review 2022; (43(5)):266-274 doi:10.1542/pir.2021-005177.

    PMID: 35490204
  4. 4

    The Double Bubble Sign: Duodenal Atresia and Associated Genetic Etiologies.

    Bishop JC, McCormick B, Johnson CT, et al.

    Fetal diagnosis and therapy 2020; (47(2)):98-103 doi:10.1159/000500471.

    PMID: 31167209
  5. 5

    Evaluation of prenatal and postnatal ultrasonography for the diagnosis of fetal double bubble sign.

    Zhang B, Zhang W, Hu Y, et al.

    Quantitative imaging in medicine and surgery 2024; (14(9)):6386-6396 doi:10.21037/qims-24-445.

    PMID: 39281137
  6. 6

    Clinical significance of prenatal double bubble sign on perinatal outcome and literature review.

    Demirci O, Eriç Özdemir M, Kumru P, Celayir A

    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2022; (35(10)):1841-1847 doi:10.1080/14767058.2021.1874338.

    PMID: 33455511
  7. 7

    Prenatal Detection of Congenital Duodenal Obstruction-Impact on Postnatal Care.

    Saalabian K, Friedmacher F, Theilen TM, et al.

    Children (Basel, Switzerland) 2022; (9(2)) doi:10.3390/children9020160.

    PMID: 35204881
  8. 8

    Clinical Analysis of Congenital Duodenal Obstruction and the Role of Annular Pancreas.

    Taşdemir Ü, Demirci O

    Medicina (Kaunas, Lithuania) 2025; (61(2)) doi:10.3390/medicina61020171.

    PMID: 40005289
  9. 9

    Use of N-Acetylcysteine in Preterm Neonates with Enteral Feeding Intolerance and Intestinal Obstruction: A Case Series and Review of the Literature.

    De Rose DU, Landolfo F, Pugnaloni F, et al.

    Children (Basel, Switzerland) 2024; (11(7)) doi:10.3390/children11070873.

    PMID: 39062322
  10. 10

    Two cases of type 1 jejunoileal atresia with multiple webs: A case report.

    Diposarosa R, Lia E, Kesek SAS, Astriana W

    International journal of surgery case reports 2024; (123()):110240 doi:10.1016/j.ijscr.2024.110240.

    PMID: 39241480
  11. 11

    Gastrointestinal Emergency in Neonates and Infants: A Pictorial Essay.

    Choi G, Je BK, Kim YJ

    Korean journal of radiology 2022; (23(1)):124-138 doi:10.3348/kjr.2021.0111.

    PMID: 34983099
  12. 12

    Presentation and outcome of treatment of jejunoileal atresia in Nigeria.

    Sholadoye TT, Mshelbwala PM, Ameh EA

    African journal of paediatric surgery : AJPS 2018; (15(2)):84-87 doi:10.4103/ajps.AJPS_120_16.

    PMID: 31290469
  13. 13

    Double Whammy: Duodenal Stenosis and Gastrointestinal Malrotation.

    Mustaqim K, Mohd Shah MS, Muhammad Asri NA

    Cureus 2023; (15(3)):e36137 doi:10.7759/cureus.36137.

    PMID: 37065346
  14. 14

    Outcomes and survival of infants with congenital duodenal obstruction following Kimura procedure with post-anastomosis jejunostomy feeding tube.

    Makkadafi M, Fauzi AR, Wandita S, et al.

    BMC gastroenterology 2021; (21(1)):100 doi:10.1186/s12876-021-01679-8.

    PMID: 33663393
  15. 15

    Comparison of outcomes following three surgical techniques for patients with severe jejunoileal atresia.

    Peng YF, Zheng HQ, Zhang H, et al.

    Gastroenterology report 2019; (7(6)):444-448 doi:10.1093/gastro/goz026.

    PMID: 31857906
  16. 16

    Outcomes of end-to-side oblique anastomosis as a surgical technique for jejuno-ileal atresia.

    Joda AE, Abdullah AF

    Updates in surgery 2019; (71(3)):587-593 doi:10.1007/s13304-019-00666-9.

    PMID: 31243726
  17. 17

    [Application of Bishop-Koop stoma in refractory congenital intestinal atresia].

    Zhang H, Zhong W, Sun J, et al.

    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 2016; (19(10)):1154-1159.

    PMID: 27781254
  18. 18

    Bishop-Koop jejunostomy in an adult following proximal small bowel anastomotic breakdown.

    Dickson-Lowe RA, Pienaar Z, Buitendag JJP, Oosthuizen G

    BMJ case reports 2018; (11(1)) doi:10.1136/bcr-2018-227519.

    PMID: 30580307
  19. 19

    Laparoscopic Versus Open Surgical Repair of Duodenal Atresia: A NSQIP-Pediatric Analysis.

    Weller JH, Engwall-Gill AJ, Westermann CR, et al.

    The Journal of surgical research 2022; (279()):803-808 doi:10.1016/j.jss.2022.04.028.

    PMID: 35487775
  20. 20

    Minimally Invasive Surgery for Duodenal Obstructions: 10 Years of Experience in a Single Center.

    Cazares J, Colín-Garnica J, Cantú-Reyes JA, et al.

    Journal of pediatric surgery 2024; (59(12)):161700 doi:10.1016/j.jpedsurg.2024.161700.

    PMID: 39304485
  21. 21

    Predictive Factors for Postoperative Outcome in Children with Jejunoileal Atresia.

    Jarkman C, Salö M

    Surgery journal (New York, N.Y.) 2019; (5(4)):e131-e136 doi:10.1055/s-0039-1697628.

    PMID: 31579829

This page explains small bowel atresia surgery and the NICU journey for educational purposes. Your baby's neonatologist and pediatric surgeon are the best sources for discussing their specific care plan and timeline.

Get notified when new evidence is published on Small bowel atresia.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.