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Congenital duodenal diaphragm in eight children
Akhtar Nawaz1, Hilal Matta, Alic Jacobsz
1Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan. tiamoor@emirates.net.ae
Insights
Congenital duodenal diaphragm (CDD) caused intrinsic duodenal obstruction in 36.4% of newborns. Early diagnosis via X-ray and barium meal, coupled with good care, led to a 100% survival rate in this study.
Area of Science:
- Pediatric Surgery
- Neonatal Gastroenterology
Background:
- Congenital duodenal obstruction (CDO) is a frequent cause of intestinal obstruction in newborns.
- Duodenal diaphragms present a diagnostic challenge within CDO.
- This study focuses on intrinsic duodenal obstruction caused by duodenal diaphragms.
Purpose of the Study:
- To report on the experience with eight children diagnosed with congenital duodenal diaphragm (CDD).
- To analyze the diagnosis, treatment, and outcomes of CDD in pediatric patients.
Main Methods:
- Retrospective review of 22 children with congenital intrinsic duodenal obstruction.
- Analysis included demographics, clinical presentation, diagnostic methods (X-ray, barium meal), surgical findings, and outcomes.
- Operative notes were used to detail procedures.
Main Results:
- Eight of 22 children (36.4%) had congenital duodenal diaphragm (CDD).
- Diagnosis was confirmed by characteristic X-ray (double-bubble) and barium meal findings.
- All patients survived, with six requiring total parenteral nutrition postoperatively.
Conclusions:
- Congenital duodenal diaphragm is a significant cause of intrinsic duodenal obstruction in newborns.
- The study achieved a 100% survival rate, comparable to Western outcomes.
- Factors contributing to success include prompt diagnosis, effective perioperative management, and availability of total parenteral nutrition.
Background:
Congenital duodenal obstruction (CDO) is a common and usually easy to diagnose cause of intestinal obstruction in the newborn, except when the cause of the obstruction is a duodenal diaphragm. We describe our experience with eight children who had intrinsic duodenal obstruction secondary to a duodenal diaphragm.
Methods:
The medical records of 22 children with the diagnosis of congenital intrinsic duodenal obstruction were reviewed for age at diagnosis, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment and outcome. Operative findings and procedures were obtained from the operative notes.
Results:
Eight of the 22 children (36.4%) had congenital duodenal diaphragm (CDD). In all children, the diagnosis was made from plain abdominal X-ray, which showed the classic double-bubble appearance, and barium meal, which showed duodenal obstruction. Four patients had associated anomalies, including two with Down's syndrome. Intraoperatively, five patients were found to have duodenal diaphragm with a central hole, while the other three had complete duodenal diaphragms. Postoperatively, all patients did well. Six required total parenteral nutrition.
Conclusions:
The 100% survival rate among these children is comparable to that in Western countries, and can be attributed to the lack of major associated abnormalities, good perioperative management, and the availability of total parenteral nutrition.
