Endoscopic resection of a duodenal web in an 11-month-old infant with multiple malformations

Bleve, Cosimo; Costa, Lorenzo; Bertoncello, V; Ferrara, Francesco; Zolpi, Elisa; Chiarenza, Salvatore Fabio

doi:10.1055/s-0034-1391777

Cited by 8 publications

(4 citation statements)

References 6 publications

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“…In this patient, the diagnosis of duodenal obstruction was delayed after thoracoscopic repair of oesophageal atresia and underwent endoscopic resection of the web [15], Figure 6.…”

Section: Resultsmentioning

confidence: 99%

Duodenal Atresia: Open versus MIS Repair—Analysis of Our Experience over the Last 12 Years

Chiarenza

Bucci

Conighi

et al. 2017

BioMed Research International

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Objective. Duodenal atresia (DA) routinely has been corrected by laparotomy and duodenoduodenostomy with excellent long-term results. We revisited the patients with DA treated in the last 12 years (2004–2016) comparing the open and the minimally invasive surgical (MIS) approach. Methods. We divided our cohort of patients into two groups. Group 1 included 10 patients with CDO (2004–09) treated with open procedure: 5, DA; 3, duodenal web; 2, extrinsic obstruction. Three presented with Down's syndrome while 3 presented with concomitant malformations. Group 2 included 8 patients (2009–16): 1, web; 5, DA; 2, extrinsic obstruction. Seven were treated by MIS; 1 was treated by Endoscopy. Three presented with Down's syndrome; 3 presented with concomitant malformations. Results. Average operating time was 120 minutes in Group 1 and 190 minutes in Group 2. In MIS Group the visualization was excellent. We recorded no intraoperative complications, conversions, or anastomotic leakage. Feedings started on 3–7 postoperative days. Follow-up showed no evidence of stricture or obstruction. In Group 1 feedings started within 10–22 days and we have 1 postoperative obstruction. Conclusions. Laparoscopic repair of DA is one of the most challenging procedures among pediatric laparoscopic procedures. These patients had a shorter length of hospitalization and more rapid advancement to full feeding compared to patients undergoing the open approach. Laparoscopic repair of DA could be the preferred technique, safe, and efficacious, in the hands of experienced surgeons.

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“…In this patient, the diagnosis of duodenal obstruction was delayed after thoracoscopic repair of oesophageal atresia and underwent endoscopic resection of the web [15], Figure 6.…”

Section: Resultsmentioning

confidence: 99%

Duodenal Atresia: Open versus MIS Repair—Analysis of Our Experience over the Last 12 Years

Chiarenza

Bucci

Conighi

et al. 2017

BioMed Research International

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“…Consequently, diaphragmatic openings are predominantly eccentrically distributed close to the papilla's side (left side) ( 17 , 19 ). If the duodenal papilla is visible in gastroscopy, the duodenal papilla can be avoided by incising the diaphragm from the opening to the opposite side of the papilla ( 10 , 11 , 17 , 20 ) ( Figure 2 ). Nose et al ( 17 , 18 , 27 ) employed a balloon-assisted traction on the diaphragm toward its proximal end to determine its extent before performing incision or ablation, thereby preventing injury to both the duodenal wall and the papilla.…”

Section: Discussionmentioning

confidence: 99%

“…These reports serve as a valuable reference for balloon dilatation in pediatric patients of varying ages. A T-shaped ( 7 – 9 ) or radial ( 11 ) incision may be superior to a linear incision in avoiding rehealing. A further enlargement of the opening by removing a part of the diaphragm by snare or biopsy forceps after diaphragmotomy can potentially prove effective ( 27 , 28 ) ( Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical application of endoscopic diaphragmotomy and dilation in a congenital duodenal diaphragm

Sun,

Zheng,

et al. 2024

Front. Pediatr.

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BackgroundA congenital duodenal diaphragm (CDD) is a rare cause of duodenal obstruction in infants and children. The traditional approach to treatment has been surgical intervention either with excision and duodenoplasty or with bypass through a duodenoduodenostomy, which is invasive and carries the risk of anastomotic leakage.AimsTo summarize the key points of differential diagnosis and treatment of a CDD under gastroscopy and to evaluate its efficacy and safety.MethodsThe clinical data of patients with a duodenal obstruction diagnosed and treated by gastroscopy in our hospital between January 2019 and December 2022 were retrospectively analyzed. The gastroscopic features of the CDD were summarized. The clinical outcomes of patients with CDD treated by gastroscopy were collected and investigated.ResultsA total of 13 children with a duodenal obstruction underwent a gastroscopic examination and/or treatment, and of these, 10 were diagnosed as having a CDD and 3 were finally diagnosed as having an annular pancreas. A dome-shaped structure during inspiration (9/10) and a guidewire that could be inserted through the opening into the distal lumen (6/10) were the gastroscopic features of the CDD, while the annular pancreas had none of these features. The 10 patients, 4 men and 6 women with the CDD, were treated through endoscopic diaphragmotomy and dilation. The age and weight at operation was 15 days to 7 years (M: 2.25 years) and 2.85–22 kg (M: 13.6 kg), respectively. A total of 11 endoscopic operations were performed in the 10 patients. The time of single operation was 15–55 min (M: 38 min). The patients did not experience complications such as bleeding, pneumoperitoneum, and duodenal papilla injury during the operation. Feeding was started 12–24 h after surgery, and the patients were discharged 2–10 days (M: 7 days) postoperatively. The patients were followed up for 3–36 months (M: 17 months), and none of them had a recurrence of vomiting. However, three showed a recurrence of stenosis in upper gastrointestinal imaging, one of whom underwent a partial diaphragm resection again 2 months after the primary treatment.ConclusionsA CDD can be confirmed by endoscopy based on its characteristic features. Endoscopic diaphragmotomy and balloon dilation are safe and effective, which can be a new option for minimally invasive treatment of a CDD.

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“…En la literatura se describen casos de resolución endoscópica en pacientes de tan solo 7 días de vida (25) . Existen reportes con excelentes resultados pronósticos en los que se realizaron tanto secciones longitudinales como circunferenciales de membranas duodenales, así como también casos en los que se realizaron secciones radiales de la membrana, con resultados promisorios (26) (27) . Las intervenciones realizadas por vía endoscópica se han asociado con poten-ciales complicaciones, dentro de las cuales se incluyen la reestenosis (23) , lesión de la ampolla de Vater (28) y perforación intestinal (29) .…”

Section: 25184/anfamed2017v4n2a7unclassified

Membrana duodenal: a propósito de un caso

Ormaechea¹,

Berazategui²

2017

An Facultad Med

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La atresia de duodeno es una causa poco frecuente de oclusión intestinal. Generalmente el diagnósti-co se realiza en etapa prenatal o en el período neonatal principalmente para aquellos casos de oclusión completa, mientras que aquellos con oclusión incompleta pueden diagnosticarse más tardíamente. Se presenta el caso clínico de una paciente con una forma de presentación infrecuente, con diagnóstico luego del año de vida. Se realizó una duodeno anastomosis, con buena evolución postoperatoria. Palabras claveAtresia de duodeno, membrana duodenal. AbstractDuodenal atresia is a rare cause of intestinal occlusion. Generally, the diagnosis is made in the prenatal stage or in the neonatal period mainly for those cases of complete occlusion, whereas those with incomplete occlusion may be diagnosed later. We present the case of a patient with an uncommon presentation, with diagnosis after one year of life. A duodenum-duodenum anastomosis was performed, with good postoperative evolution. Key WordsDuodenal atresia, duodenal membrane. ResumoA atresia duodenal é uma causa rara de oclusão intestinal. O diagnóstico geralmente é feito no estágio pré-natal ou no período neonatal principalmente para os casos de oclusão completa, enquanto aqueles com oclusão incompleta podem ser diagnosticados mais tarde. Apresentamos o caso de uma paciente com uma apresentação incomum, com diagnóstico após o ano de vida. Uma anastomose duodeno foi realizada, com boa evolução pós-operatória.

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Endoscopic resection of a duodenal web in an 11-month-old infant with multiple malformations

Cited by 8 publications

References 6 publications

Duodenal Atresia: Open versus MIS Repair—Analysis of Our Experience over the Last 12 Years

Duodenal Atresia: Open versus MIS Repair—Analysis of Our Experience over the Last 12 Years

Clinical application of endoscopic diaphragmotomy and dilation in a congenital duodenal diaphragm

Membrana duodenal: a propósito de un caso

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