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Duodenal obstruction in Nigerian newborns and infants
1Department of Surgery, Lagos University Teaching Hospital, University of Lagos, Nigeria.
Insights
Congenital duodenal obstruction in infants is challenging in tropical settings. Early surgical intervention within 8 days significantly improves survival rates, reducing mortality.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Tropical Medicine
Background:
- Congenital duodenal obstruction presents unique challenges in tropical environments.
- Management strategies require adaptation to resource-limited settings.
- Understanding specific etiological factors is crucial for effective treatment.
Purpose of the Study:
- To analyze the management of congenital duodenal obstruction in infants within a tropical setting.
- To identify challenges and propose solutions for improving outcomes.
- To evaluate the impact of presentation timing and available facilities on mortality.
Main Methods:
- Retrospective analysis of 30 infants treated for duodenal obstruction.
- Review of diagnoses including duodenal atresia, Ladd's bands, and duodenal diaphragm.
- Assessment of associated anomalies and treatment outcomes.
Main Results:
- Duodenal atresia was the most common diagnosis (50%), followed by Ladd's bands (23%) and duodenal diaphragm (20%).
- Associated anomalies included distal bowel atresia, partial situs inversus, and Trisomy 21.
- A 28% mortality rate was observed, with all deaths occurring in infants presenting after 8 days of life or with incomplete obstruction.
Conclusions:
- Delay in presentation and inadequate facilities are significant barriers to successful management.
- Timely surgical intervention, ideally within the first 8 days of life, dramatically improves survival.
- Improving healthcare infrastructure and public health education can reduce mortality from congenital duodenal obstruction.
Abstract:
Experience with the management of congenital duodenal obstruction in a tropical environment is analysed with a view to highlighting some of the problems and suggesting solutions. 30 infants with duodenal obstruction were treated at the Lagos University Teaching Hospital between 1978 and 1985. 15 (50%) infants had duodenal atersia. 7 (23%) had Ladd's bands, 6 (20%) had duodenal diaphragm and there was one bay with partial duodenal obstruction caused by a duplication cyst. The associated abnormalities encountered in 7 infants are distal bowel atresia (3), partial situs inversus (3) and Trisomy 21 (1). Delay in presentation and inadequate facilities constituted the major constraints. 7 of the 25 infants that had corrective surgery died, a mortality of 28%. All the infants that were treated within the first 8 days of life survived. After this period survival was restricted to those with incomplete obstruction. Mortality can be reduced by the provision of adequate facilities and health education.