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Membranous duodenal stenosis
C Mikaelsson1, E Arnbjörnsson, C M Kullendorff
1Department of Paediatric Surgery, University Hospital, Lund, Sweden.
Insights
Membranous duodenal stenosis in infants presents differently than duodenal atresia, often leading to delayed diagnosis. Early surgical intervention shows good outcomes, supporting its classification as a distinct entity.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Malformations
Background:
- Membranous duodenal stenosis is a rare congenital anomaly.
- It can be misdiagnosed as duodenal atresia, delaying appropriate treatment.
- Understanding its unique presentation is crucial for timely intervention.
Purpose of the Study:
- To report the clinical experience of patients with membranous duodenal stenosis.
- To analyze treatment strategies and outcomes.
- To differentiate membranous duodenal stenosis from duodenal atresia.
Main Methods:
- Retrospective analysis of 16 patients treated for membranous duodenal stenosis.
- Review of presenting symptoms, associated malformations, surgical procedures, and postoperative courses.
- Comparison of clinical presentation with duodenal atresia.
Main Results:
- Non-bile-stained vomiting was the predominant presenting symptom.
- Associated malformations, including Down syndrome, were common.
- Surgical procedures included partial excision with duodenoplasty, duodenojejunostomy, or duodenoplasty alone.
- No lethal complications occurred postoperatively; one late stricture was noted.
Conclusions:
- Membranous duodenal stenosis has distinct clinical features compared to duodenal atresia.
- Misinterpretation can lead to delayed diagnosis.
- It should be recognized and managed as a separate entity.
Abstract:
The experience of our 16 patients treated for membranous duodenal stenosis is reported. Their treatment and course was analysed in a retrospective study. Eight patients were operated on within the first 16 days of life and in the remaining group surgery was performed at 1 month to 4 y of age. The presenting symptom leading to diagnosis was, in all but one case, non-bile-stained vomiting. Associated malformations were found in all but four patients, mostly morbus Down. The operative procedure performed was a partial excision of the duodenal membrane and a duodenoplasty in 10 patients, a duodenojejunostomy in 5 patients, and a duodenoplasty only in 1 patient. The postoperative course was without lethal complications. One late stricture in an anastomosis occurred. We conclude that in its presentation, duodenal stenosis differs from duodenal atresia, and can often be misinterpreted, resulting in a late diagnosis, and should be reported as a separate entity.