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Congenital intrinsic duodenal obstruction: problems in the diagnosis and management
A H al-Salem1, S Khwaja, C Grant
1Department of Surgery, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia.
Insights
Intrinsic duodenal obstruction in infants often presents with atresia and is frequently associated with Down's syndrome. Early diagnosis and management are crucial for improving outcomes in these complex cases.
Area of Science:
- Pediatric Surgery
- Neonatalogy
- Medical Genetics
Background:
- Intrinsic duodenal obstruction is a significant cause of neonatal surgical emergencies.
- Associated anomalies, particularly Down's syndrome, are common in infants with duodenal obstruction.
- Delayed diagnosis can lead to increased morbidity and mortality.
Purpose of the Study:
- To analyze the clinical presentation, associated anomalies, and outcomes of infants with intrinsic duodenal obstruction.
- To evaluate the impact of diagnostic delays and surgical management on patient outcomes.
- To propose a diagnostic and management algorithm for intrinsic duodenal obstruction.
Main Methods:
- Retrospective analysis of 19 infants diagnosed with intrinsic duodenal obstruction.
- Review of patient records, including associated anomalies, diagnostic timelines, and operative procedures.
- Assessment of mortality and morbidity related to the condition and its management.
Main Results:
- Atresia was the most frequent lesion (73.7% had associated anomalies).
- Down's syndrome was present in 47% of infants; diagnosis was delayed in 7/19 infants.
- Mortality was 15.8% (3/19), with causes including prematurity, anomalies, peritonitis, and metabolic derangements.
Conclusions:
- Intrinsic duodenal obstruction in infants frequently involves atresia and is highly associated with congenital anomalies, especially Down's syndrome.
- Diagnostic delays and prematurity contribute to poor outcomes.
- A structured approach to diagnosis and management is essential for optimizing care.
Abstract:
Nineteen infants with intrinsic duodenal obstruction are analyzed. Atresia was the most common lesion. An exceptionally high rate of associated anomalies (73.7%) were present; Down's syndrome, the single most common anomaly, was seen in 47% of the infants. In seven infants, the diagnosis was delayed and in another three it was made intraoperatively while establishing a gastrostomy for esophageal atresia. Three infants died without operation because of gross prematurity and multiple anomalies. Of the 16 operated on, three died, one due to peritonitis and the other two because of metabolic derangements. Of the various operative procedures used, no significant difference was found in the final outcome of treatment. A schematic approach to the diagnosis and management is proposed.