Comparison of outcomes between complete and incomplete congenital duodenal obstruction

Abstract

BACKGROUND Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes. AIM To quantify and compare the association between CCDO and ICDO with outcome parameters. METHODS We retrospectively reviewed all patients who underwent operative repair of CCDO or ICDO in our tertiary care institution between January 2004 and January 2017. The demographics, clinical presentation, preoperative diagnostics and postoperative outcomes of 50 patients were compared between CCDO ( n = 27; atresia type 1-3, annular pancreas) and ICDO ( n = 23; annular pancreas, web, Ladd´s bands). RESULTS In total, 50 patients who underwent CDO repair were enrolled and followed for a median of 5.2 and 3.9 years (CCDO and ICDO, resp.). CCDO was associated with a significantly higher prenatal ultrasonographic detection rate (88% versus 4%; CCDO vs ICDO, P < 0.01), lower gestational age at birth, lower age and weight at operation, higher rate of associated congenital heart disease (CHD), more extensive preoperative radiologic diagnostics, higher morbidity according to Clavien-Dindo classification and comprehensive complication index (all P ≤ 0.01). The subgroup analysis of patients without CHD and prematurity showed a longer time from operation to the initiation of enteral feeds in the CCDO group ( P < 0.01). CONCLUSION CCDO and ICDO differ with regard to prenatal detection rate, gestational age, age and weight at operation, rate of associated CHD, preoperative diagnostics and morbidity. The degree of CDO in mature patients without CHD influences the postoperative initiation of enteral feeding.

Prognostic factors for mortality in patients with congenital duodenal obstruction at DR. Moewardi Hospital Surakarta

“…This is consistent with the finding of Gfroerer et al that the mortality rate was higher in total obstruction with heart defects as the main cause of death. 4 The underlying mechanisms of death in patients with duodenal obstruction are still not fully understood, but several studies suggest that asphyxia, bradycardia/asystole, sepsis, increased bile acid levels, to cardiac anomalies were the underlying cause. 4,21,22 8 | CONCLUSION…”

“…Patients in this subgroup had longer hospital stays, with a higher morbidity rate when compared with the partial obstruction subgroup (Figure 1). 4,10…”

“…Mortality is found more in total obstruction, with heart defects as the main cause of death. 4 4 | CONCEPTUAL FRAMEWORK…”

“…Mortality in this case was associated with congenital heart disease. The grade of duodenal obstruction is said to have an impact on postoperative outcomes 3,4,10 …”

“…Those two types of obstruction have different mortality rates. 3,4 Other factors that are thought to influence mortality in cases of congenital duodenal obstruction are gestational age and birth weight.…”