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Congenital duodenal obstruction with delayed presentation: seven years of experience

Seyed Abdollah Mousavi1, Hasan Karami2, Hossein Saneian3

  • 1Department of Pediatric Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Archives of Medical Science : AMS
|October 4, 2016
PubMed

Insights

Congenital duodenal webs can cause later-age obstruction, presenting as failure to thrive. Early diagnosis of these duodenal obstructions is crucial for better outcomes.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Congenital Malformations

Background:

  • Congenital intestinal obstruction commonly affects the duodenum.
  • Duodenal webs with fenestrations may not show immediate signs of obstruction.
  • Late presentation can lead to significant complications.

Purpose of the Study:

  • To evaluate complications and operative findings in children with congenital intestinal obstruction.
  • To analyze cases of duodenal webs presenting later in childhood.
  • To highlight the importance of timely diagnosis.

Main Methods:

  • Retrospective review of pediatric congenital intestinal obstruction cases over 7 years.
  • Analysis of operative findings, including duodenal atresia, annular pancreas, malrotation, and fenestrated duodenal webs.
  • Evaluation of patient demographics, associated conditions (e.g., trisomy 21), and clinical presentations.

Main Results:

  • 81 infants with congenital intestinal obstruction were identified.
  • Fenestrated duodenal webs were found in 8 patients, with ages ranging from 5 days to 72 months.
  • Late-presenting patients (over 2 years) experienced complications like gastroesophageal reflux, esophageal ulcer, stricture, and dysphagia. A unique case involved a patient with a massive fruit seed bezoar.

Conclusions:

  • Duodenal webs can present subtly in later childhood with failure to thrive and food intolerance, mimicking other conditions.
  • A high index of suspicion is vital for diagnosing duodenal webs presenting beyond the typical neonatal period.
  • Prompt diagnosis and intervention are essential to prevent severe complications associated with congenital duodenal obstruction.
Abstract

Keywords:
duodenumobstructionweb

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