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Published on: December 15, 2023
Delayed presentation of duodenal atresia
Charu Tiwari1, Nitinkumar Bhajandas Borkar1, Sunita Singh1
1Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India.
Insights
Fenestrated duodenal webs, a type of duodenal atresia, can cause delayed symptoms in infants. This study reviewed six cases, highlighting diagnostic challenges and proposing a classification modification for better diagnosis.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastrointestinal Surgery
Background:
- Duodenal atresia (DA), specifically Type I (duodenal web/membrane), can manifest later in infancy or childhood if fenestrated.
- Delayed presentation of DA due to fenestrated duodenal webs poses diagnostic challenges for pediatric surgeons.
- This study focuses on six pediatric patients with delayed presentation of DA caused by fenestrated webs.
Purpose of the Study:
- To describe the clinical characteristics and management of pediatric patients with delayed presentation of duodenal atresia due to fenestrated duodenal webs.
- To highlight the diagnostic challenges associated with fenestrated duodenal webs.
- To propose a modification to the existing classification of duodenal atresia for improved epidemiological reporting and early diagnosis.
Main Methods:
- Retrospective review of hospital records for six pediatric patients managed for delayed presentation of DA due to fenestrated webs.
- Data analysis included age at presentation, clinical symptoms, associated anomalies, radiological findings, intra-operative findings, surgical management, and postoperative outcomes.
- The study period spanned two years (January 2019 to December 2020) at a tertiary care institute.
Main Results:
- The median age of presentation was 6.5 months (range: 1 month to 10 years), with four males and two females.
- Emesis was the most common presenting symptom in all six patients.
- Fenestrated duodenal membranes (preampullary or postampullary) were confirmed intra-operatively in all patients, who underwent web excision with lateral duodenotomy and transverse closure. Postoperative recovery was uneventful with a mean hospital stay of 9 days.
Conclusions:
- Fenestrated duodenal webs present significant diagnostic challenges due to their variable and delayed clinical presentation in pediatric patients.
- A modified classification for DA is proposed to enhance the reporting of epidemiology and facilitate earlier diagnosis of this congenital anomaly.
- Surgical management involving web excision is effective, leading to favorable postoperative outcomes.
Background:
The most common type of duodenal atresia (DA) (Type I), also known as duodenal web or membrane can present later in infancy or early childhood if the membrane or web is fenestrated. We describe six patients with delayed presentation of DA.
Materials And Methods:
Retrospective review of hospital records of six patients with delayed presentation of DA due to fenestrated web managed in Paediatric Surgery Department at a tertiary care institute over a period of 2 years (January 2019 to December 2020) was done. The data of these patients were analysed on the basis of age at presentation, clinical presentation, associated anomalies, radiological findings, intra-operative findings, management and postoperative course.
Results:
The median age at presentation was 6.5 months (range: 1 month to 10 years). There were four males and two females. The most common presentation was emesis seen in all six patients. Two patients had Down syndrome. Associated congenital anomalies were cardiac in one patient, anterior ectopic anus in one patient and malrotation of midgut in one patient. Upper gastrointestinal contrast suggested incomplete duodenal obstruction in all patients. At laparotomy, fenestrated duodenal membrane was observed in all patients - preampullary in three patients and postampullary in three patients. Lateral duodenotomy, web excision and transverse closure was done in all six patients. The postoperative period was uneventful in all patients and mean duration of hospital stay was 9 days.
Conclusion:
Fenestrated duodenal webs present a diagnostic challenge to the paediatric surgeons because of delayed and variable clinical presentation. A modification of the present classification of DA has been proposed in this study which would help in better reporting of epidemiology and aid in early diagnosis of this congenital anomaly.
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