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Intestinal blind pouch- and blind loop- syndrome in children operated previously for congenital duodenal obstruction
Insights
This study followed 27 children treated for congenital duodenal obstruction (CDO). A 14% rate of blind pouch syndrome was observed after duodenojejunostomy, highlighting the need for wider anastomoses.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Congenital Malformations
Background:
- Congenital duodenal obstruction (CDO) requires surgical intervention in infants.
- Long-term outcomes of various surgical procedures for CDO are not well-documented.
- This study evaluates the late results of operations performed between 1953 and 1971.
Observation:
- 27 children with intrinsic or extrinsic CDO underwent procedures including duodenojejunostomy, Ladd's operation, and duodenolysis.
- Follow-up ranged from 3 to 21 years post-surgery.
- Three patients had moderate duodenal dilatation without requiring reoperation.
Findings:
- One case of blind pouch syndrome with phytobezoar occurred 4.5 years after duodenojejunostomy (14% incidence).
- A blind loop syndrome developed in the ileocecal segment 3 months after ileotransversostomy for adhesions.
- Both complications were successfully resected.
Implications:
- Wider anastomoses are crucial to prevent blind pouch and blind loop syndromes.
- End-to-end anastomosis is preferred in jejuno-ileo-colic surgery to minimize these risks.
- Long-term surveillance is important for patients operated on for CDO.
Abstract:
A follow-up study of 27 children operated for congenital duodenal obstruction (CDO) in the years 1953--71 is presented. Nine children belonged to the intrinsic and 18 children to the extrinsic group of CDO. A total of 7 retrocolic, isoperistaltic, side-to-side duodeno-jejunostomy, 7 Ladd's operation, 8 duodenolysis, 2 reduction of midgut volvulus, 2 duodenostomy a.m. Morton and one gastro-jejunostomy were performed at the age of 1 day--15 years. The clinical and radiological examinations were performed 3--21 years (mean 10 years 2 months) after these operations. In 3 cases there was a moderate duodenal dilatation, but reoperation was not necessary. During the follow-up period, one boy, now aged 8 years, developed a blind pouch-syndrome in the I portion of the duodenum containing a 5 x 5 cm phytobezoar 4 1/2 years after duodeno-jejunostomy. The frequency of blind pouch-syndrome after duodeno-jejunostomy was thus 1:7 or 14%. One girl, now aged 9 years, developed a blind loop-syndrome in the ileocaecal segment 3 months after side-to-side ileotransversostomy, which was performed from adhesion-obstruction after duodenolysis for malrotation I and CDO. Both the blind pouch- and the blind loop-deformation were resected and the children recovered well. To avoid blind-pouch- and blind loop-deformations in the intestines, the anastomosis must be made wide enough, and especially in the surgery of the jejuno-ileo-colic region an end-to-end anastomosis is preferable.