Congenital duodenal obstruction: a review of 82 cases

We report our experience with 82 cases of congenital duodenal obstruction. Forty-seven had intrinsic and 35 extrinsic lesions. Treatment of duodenal occlusion resulting from maldevelopment of the common mesentery is well standardized. Treatment of occlusion due to duodenal atresia or complete diaphragmatic obstruction needs re-evaluation. Our critical study of the anastomoses commonly used emphasizes that duodenojejunostomy and gastrojejunostomy should be avoided. The recommended operative technique had the following aims in order to utilize fully the duodenal circuit: 1) Reduction in size and remodeling of the proximal dilated duodenal segment; 2) End-to-end anastomosis of the proximal duodenum with the distal duodenum or the jejunum. Only the "annular pancreas" lesion is not fully amenable to this technique but, even here, an end-to-side anastomosis is eminently feasible.