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Congenital duodenal obstruction: a 32-year review
P V Bailey1, T F Tracy, R H Connors
1Department of Surgery, St Louis University School of Medicine, MO.
Insights
Congenital duodenal obstruction in infants presents challenges, with intrinsic and extrinsic defects common. Surgical repair achieved a 93% survival rate, though associated anomalies and reoperations impact outcomes.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Gastrointestinal Surgery
Background:
- Congenital duodenal obstruction remains a significant challenge in infant surgical care.
- Despite improved survival rates, specific complexities associated with duodenal anomalies persist.
Purpose of the Study:
- To analyze the clinical presentation, management, and outcomes of congenital duodenal obstruction in a cohort of newborns and infants.
- To identify associated anomalies and their impact on treatment and survival.
Main Methods:
- Retrospective review of 138 infants (0-30 days) treated for congenital duodenal obstruction.
- Analysis of defect types (intrinsic, extrinsic, combined), presenting signs, diagnostic methods, surgical procedures, and outcomes.
- Evaluation of associated anomalies and reoperation rates.
Main Results:
- Vomiting (90%) and abdominal distention (25%) were primary symptoms; 45% of infants were premature.
- Intrinsic defects (atresia, web, stenosis, duplication) and extrinsic defects (annular pancreas, malrotation) were identified.
- Associated anomalies, including Down's syndrome (11%), were present in 38% of patients.
- Ladd's procedure (31%) and duodenoduodenostomy (14%) were common repairs; 93% overall survival.
- Reoperation was required in 14% for various complications.
Conclusions:
- Congenital duodenal obstruction requires prompt diagnosis and surgical intervention.
- Associated anomalies significantly influence patient management and prognosis.
- While survival is high, reoperations highlight the long-term challenges in managing these complex cases.
Abstract:
Although survival in infants with congenital intestinal obstruction has improved, duodenal obstruction continues to present unique challenges. One hundred thirty-eight newborns and infants (aged 0 to 30 days) were treated for congenital duodenal obstruction. Sixty-five were boys and 73 were girls. Sixty-one (45%) were premature. Forty-six had an intrinsic defect (atresia, web, stenosis, or duplication), 64 had an extrinsic defect (annular pancreas or malrotation with congenital bands), while 28 had various combinations of these. Presenting signs included vomiting (90%, bilious in 66%), abdominal distention (25%), dehydration (24%), and weight loss (17%). Although plain film abdominal x-ray was diagnostic in 58%, upper and/or lower gastrointestinal contrast studies were obtained in 71% of infants to confirm diagnosis. Thirty-eight percent of patients had associated anomalies, including Down's syndrome (11%), cardiac defects, other atresia, other trisomy syndrome, imperforate anus, and central nervous system anomalies. Fourteen patients (10%) had 3 or more other anomalies, many of which required additional surgical therapy. The operative repair of the various defects included Ladd's procedure for malrotation (31%), duodenoduodenostomy (14%), duodenojejunostomy (22%), gastrojejunostomy or gastroduodenostomy (4%), excision of the web and duodenoplasty (3%), or combination of the above (22%). Gastrostomy was placed in 61%. One hundred twenty-eight patients survived (93%). The causes of death were combinations of sepsis, pneumonia, brain hemorrhage, short bowel, and cardiac anomaly. Eight of 10 (80%) who died had other serious anomalies. Twenty patients (14%) required reoperation 5 days to 4 years postoperatively for obstructing lesions (5), wound dehiscence (3), anastomotic leak or dysfunction (6), other atresias (2), choledochal cyst (1), pyloric stenosis (1), and gastroesophageal reflux (2).(ABSTRACT TRUNCATED AT 250 WORDS)