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Congenital duodenal obstruction in neonates: a decade's experience from one center
Qing-Jiang Chen, Zhi-Gang Gao, Jin-Fa Tou, Yun-Zhong Qian, Min-Ju Li, Qi-Xing Xiong, Qiang Shu
Hangzhou, China
Author Affiliations: Department of Pediatric General Surgery (Chen QJ, Gao ZG, Tou JF, Qian YZ, Li MJ, Xiong QX), and Department of Pediatric Thoracic Surgery, Children's Hospital, Zhejiang University Shool of Medicine, Hangzhou 310003, China (Shu Q)
Corresponding Author: Qiang Shu, Department of Pediatric Thoracic Surgery, Children's Hospital, Zhejiang University Shool of Medicine, 57 Zhugan Xiang, Hangzhou 310003, China (Tel: +86-571-87033296; Fax: +86-571-87033296; Email: shuqiang@zju.edu.cn)
doi: 10.1007/s12519-014-0499-4
Background: Congenital duodenal obstruction (CDO) is one of the most common anomalies in newborns, and accounting for nearly half of all cases of neonatal intestinal obstruction. This study aimed to review our single-center experience in managing congenital duodenal obstruction while evaluate the outcomes.
Methods: We conducted a retrospective analysis of the records of all neonates dianogsed with congenital duodenal obstruction admitted to our center between January 2003 and December 2012. We analyzed demographic criteria, clinical manifestations, associated anomalies, radiologic findings, surgical methods, postoperative complications, and final outcomes.
Results: The study comprised 287 newborns (193 boys and 94 girls). Birth weight ranged from 950 g to 4850 g. Fifty-three patients were born prematurely between 28 and 36 weeks' gestation. Malrotation was diagnosed in 174 patients, annular pancreas in 66, duodenal web in 55, duodenal atresia or stenosis in 9, preduodenal portal vein in 2, and congenital band compression in 1. Twenty patients had various combinations of these conditions. Presenting symptoms included bilious vomiting, dehydration, and weight loss. X-rays of the upper abdomen demonstrated the presence of a typical double-bubble sign or air-fluid levels in 68.64% of patients, and confirmatory upper and/or lower gastrointestinal contrast studies were obtained in 64.11%. Multiple associated abnormalities were observed in 50.52% of the patients. Various surgical approaches were used, including Ladd's procedure, duodenoplasty, duodenoduodenostomy, duodenojejunostomy, or a combination of these. Seventeen patients died postoperatively and 14 required re-operation.
Conclusions: Congenital duodenal obstruction is a complex entity with various etiologies and often includes multiple concomitant disorders. Timely diagnosis and aggressive surgery are key to improving prognosis. Care should be taken to address all of the causes of duodenal obstruction and/or associated alimentary tract anomalies during surgery.
World J Pediatr 2014;10(3):238-244
Key words: congenital;
duodenal obstruction;
neonate
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