Congenital duodenal obstruction: A 32-year review

Bailey, Patrick V.; Tracy, Thomas F.; Connors, Robert H.; Mooney, David P.; Lewis, James E.; Weber, Thomas

doi:10.1016/s0022-3468(05)80364-1

Cited by 158 publications

(131 citation statements)

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“…Previously reported case series of duodenal atresia have focused on operative complications and associated mortality. 1,12,13 None of the reports have discussed delayed diagnosis as a contributor to increased morbidity or mortality. One of eight (12.5%) infants with delayed diagnosis in our report died as a result of the metabolic and pulmonary disturbances related to the proximal bowel obstruction.…”

Section: Congenital Duodenal Obstruction H Kilbride Et Almentioning

confidence: 99%

Congenital duodenal obstruction: timing of diagnosis during the newborn period

2009

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Objective: To determine age at diagnosis for congenital duodenal obstruction in the neonatal period and the relationship to clinical outcomes.Study Design: A children's hospital database reflecting a 7 ½-year period was reviewed to identify infants with the diagnosis of duodenal obstruction in the neonatal period. Infants were grouped according to time of diagnosis: antepartum, postpartum in-hospital or after hospital discharge. Clinical descriptors and outcome variables were assessed between infants in these three groups.Result: In total, 27/51 (53%) infants were diagnosed antenatally. Infants with prenatal diagnosis were less mature, more likely to have Down syndrome or other birth defects and the pregnancy was more likely to be complicated by polyhydramnios. Of the 24 infants diagnosed postnatally, 8 (33%) were diagnosed after hospital discharge. These infants tended to be breast fed and discharged before 48 h of age. They had greater weight loss and more metabolic disturbances at readmission for surgery. One infant in the late diagnosis group died.Conclusion: Infants with congenital duodenal obstruction, particularly if breast fed, may not present with classical findings of upper gastrointestinal obstruction in the first days of life. Careful in-hospital evaluation of infants with persistent regurgitation, even low volume, is recommended to avoid missing this diagnosis.

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Section: Congenital Duodenal Obstruction H Kilbride Et Almentioning

confidence: 99%

Congenital duodenal obstruction: timing of diagnosis during the newborn period

2009

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“…In addition, to our knowledge, this is the largest reported body of experience with this anomaly in children presented in the English literature. Other large studies of pediatric duodenal obstruction included patients with annular pancreas but did not analyze them separately [8,9]. Our review aimed specifically to define the clinical, radiographic, therapeutic, and outcome characteristics of patients with duodenal obstruction.…”

Section: Introductionmentioning

confidence: 99%

Annular Pancreas in Children: A Decade of Experience

Yiğiter

Yildiz

Firinci

et al. 2010

EAJM

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Objective: Annular pancreas is an uncommon cause of duodenal obstruction in children. In this study, the clinical, radiological, and prognostic fi ndings related to this disorder over a 12-year review period were analyzed. Materials and Methods:A retrospective review of 22 patients with annular pancreas who were treated with surgical repair between April 1998 and February 2010 was performed at two diff erent pediatric surgical units. Presenting symptoms, associated anomalies, radiological fi ndings, the type of surgery performed, postoperative outcomes, and complications were analyzed.Results: Twenty-two patients were identifi ed. Thirteen of the 22 patients (59.1%) were born prematurely, 11 patients (50%) had low birth weight, 2 patients (9.1%) had very low birth weight and 1 patient (4.5%) had extremely low birth weight. The mean birth weight was 2285.23±675.12 g. (970-3300). All patients presented with vomiting, which was bilious in nine (40.9%). Nine patients (40.9%) had chromosomal anomalies. Corrective surgery consisted of duodenoduodenostomy in 9 patients (40.9 %), duodenojejunostomy in 9 patients (40.9%), and gastrojejunostomy in 4 patients (18.1%). Fourteen of the 22 patients have survived (63.6%). The causes of death were combinations of sepsis, pneumonia, brain hemorrhage, and cardiac anomaly. Conclusion:Infants with annular pancreas associated with duodenal obstruction were often born prematurely and/or had low birth weights; many had cardiovascular anomalies. Annular pancreas associated with duodenal obstruction correlated strongly with the trisomy 21 karyotype among the chromosomal anomalies, as did duodenal atresia. The oral feeding tolerance time was nearly the same for all patients regardless of the surgical procedure used.

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“…Also "double bubble" sign with gaseous distension of the stomach and proximal duodenum and total absence of intestinal gas distally are diagnostic radiographic signs. [3][4][5] However if small bowel gas is observed distal to the double bubble, the differential diagnosis should include duodenal stenosis, duodenal web and intestinal malrotation with midgut volvulus; thus congenital duodenal stenosis may be difficult to diagnose in comparison to duodenal atresia.…”

Section: Discussionmentioning

confidence: 99%