World Journal of Pediatrics

, Volume 10, Issue 3, pp 238–244 | Cite as

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
Original Article

Abstract

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.

Key words

congenital duodenal obstruction neonate 

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References

  1. 1.
    Lawrence MJ, Ford WD, Furness ME, Hayward T, Wilson T. Congenital duodenal obstruction: early antenatal ultrasound diagnosis. Pediatr Surg Int 2000;16:342–345.PubMedCrossRefGoogle Scholar
  2. 2.
    Bailey PV, Tracy TF Jr, Connors RH, Mooney DP, Lewis JE, Weber TR. Congenital duodenal obstruction: a 32-year review. J Pediatr Surg 1993;28:92–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Mustafawi AR, Hassan ME. Congenital duodenal obstruction in children: a decade’s experience. Eur J Pediatr Surg 2008;18:93–97.PubMedCrossRefGoogle Scholar
  4. 4.
    Ladd WE. Congenital duodenal obstruction. Surgery 1937;1:878–885.Google Scholar
  5. 5.
    Kaddah SN, Bahaa-Aldin KHK, Aly HF, Hassan HS. Congenital duodenal obstruction. Ann Pediatr Surg 2006;2:130–135.Google Scholar
  6. 6.
    Bittencourt DG, Barini R, Marba S, Sbragia L. Congenital duodenal obstruction: does prenatal diagnosis improve the outcome? Pediatr Surg Int 2004;20:582–585.PubMedCrossRefGoogle Scholar
  7. 7.
    Kilbride H, Castor C, Andrews W. Congenital duodenal obstruction: timing of diagnosis during the newborn period. J Perinatol 2010;30:197–200.PubMedCrossRefGoogle Scholar
  8. 8.
    Zhang Q, Chen Y, Hou D, Guo W. Analysis of postoperative reoperation for congenital duodenal obstruction. Asian J Surg 2005;28:38–40.PubMedCrossRefGoogle Scholar
  9. 9.
    Grosfeld JL, Rescorla FJ. Duodenal atresia and stenosis: reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long term follow-up. World J Surg 1993;17:301–309.PubMedCrossRefGoogle Scholar
  10. 10.
    Romero R, Ghidini A, Costigan K, Touloukian R, Hobbins JC. Perinatal diagnosis of duodenal atresia: does it make any difference? Obstct Gynecol 1988;71:739–741.Google Scholar
  11. 11.
    Phelps S, Fisher R, Partington A, Dykes E. Prenatal ultrasound diagnosis of gastrointestinal malformations. J Pediatr Surg 1997;32:438–440.PubMedCrossRefGoogle Scholar
  12. 12.
    Lawrence MJ, Ford WD, Furness ME, Hayward T, Wilson T. Congenital duodenal obstruction: early antenatal ultrasound diagnosis. Pediatr Surg Int 2000;16:342–345.PubMedCrossRefGoogle Scholar
  13. 13.
    Cohen-Overbeek TE, Grijseels EW, Niemeijer ND, Hop WC, Wladimiroff JW, Tibboel D. Isolated or non-isolated duodenal obstruction: perinatal outcome following prenatal or postnatal diagnosis. Ultrasound Obstet Gynecol 2008;32:784–792.PubMedCrossRefGoogle Scholar
  14. 14.
    Spigland N, Yazbeck S. Complications associated with surgical treatment of congenital intrinsic duodenal obstruction. J Pediatr Surg 1990;25:1127–1130.PubMedCrossRefGoogle Scholar
  15. 15.
    Zhang XW, Abudoureyimu A, Zhang TC, Zhao JR, Fu LB, Lin F, et al. Tapering duodenoplasty and gastrojejunostomy in the management of idiopathic megaduodenum in children. J Pediatr Surg 2012;47:1038–1042.PubMedCrossRefGoogle Scholar
  16. 16.
    Alexander F, Difiore J, Stallion A. Triangular tapered duodenoplasty for the treatment of congenital duodenal obstruction. J Pediatr Surg 2002;37:862–864.PubMedCrossRefGoogle Scholar
  17. 17.
    Frantzides CT, Madan AK, Gupta PK, Smith C, Keshavarzian A. Laparoscopic repair of congenital duodenal obstruction. J Laparoendosc Adv Surg Tech A 2006;16:48–50.PubMedCrossRefGoogle Scholar
  18. 18.
    Hill S, Koontz CS, Langness SM, Wulkan ML. Laparoscopic versus open repair of congenital duodenal obstruction in infants. J Laparoendosc Adv Surg Tech A 2011;21:961–963.PubMedCrossRefGoogle Scholar
  19. 19.
    Rothenberg SS. Laparoscopic duodenoduodenostomy for duodenal obstruction in infants and children. J Pediatr Surg 2002;3:1088–1089.CrossRefGoogle Scholar
  20. 20.
    Spilde TL, St Peter SD, Keckler SJ, Holcomb GW 3rd, Snyder CL, Ostlie DJ. Open vs laparoscopic repair of congenital duodenal obstructions: a concurrent series. J Pediatr Surg 2008;43:1002–1005.PubMedCrossRefGoogle Scholar
  21. 21.
    Kay S, Yoder S, Rothenberg S. Laparoscopic duodenoduodenostomy in the neonate. J Pediatr Surg 2009;44:906–908.PubMedCrossRefGoogle Scholar
  22. 22.
    Li B, Chen WB, Zhou WY. Laparoscopic methods in the treatment of congenital duodenal obstruction for neonates. J Laparoendosc Adv Surg Tech A 2013;23:881–884.PubMedCrossRefGoogle Scholar
  23. 23.
    Jensen AR, Short SS, Anselmo DM, Torres MB, Frykman PK, Shin CE, et al. Laparoscopic versus open treatment of congenital duodenal obstruction: multicenter short-term outcomes analysis. J Laparoendosc Adv Surg Tech A 2013;23:876–880.PubMedCrossRefGoogle Scholar
  24. 24.
    Burgmeier C, Schier F. The role of laparoscopy in the treatment of duodenal obstruction in term and preterm infants. Pediatr Surg Int 2012;28:997–1000.PubMedCrossRefGoogle Scholar
  25. 25.
    Hagendoorn J, Vieira-Travassos D, van der Zee D. Laparoscopic treatment of intestinal malrotation in neonates and infants: retrospective study. Surg Endosc 2011;25:217–220.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Mooney D, Lewis JE, Connors RH, Weber TR. Newborn duodenal atresia: an improving outlook. Am J Surg 1987;153:347–349.PubMedCrossRefGoogle Scholar
  27. 27.
    Escobar MA, Ladd AP, Grosfeld JL, West KW, Rescorla FJ, Scherer LR 3rd, et al. Duodenal atresia and stenosis: long-term follow-up over 30 years. J Pediatr Surg 2004;39:867–871.PubMedCrossRefGoogle Scholar
  28. 28.
    Niramis R, Anuntkosol M, Tongsin A, Mahatharadol V. Influence of Down’s syndrome on management and outcome of patients with congenital intrinsic duodenal obstruction. J Pediatr Surg 2010;45:1467–1472.PubMedCrossRefGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Qing-Jiang Chen
    • 1
  • Zhi-Gang Gao
    • 1
  • Jin-Fa Tou
    • 1
  • Yun-Zhong Qian
    • 1
  • Min-Ju Li
    • 1
  • Qi-Xing Xiong
    • 1
  • Qiang Shu
    • 2
    • 3
  1. 1.Department of Pediatric General Surgery, Children’s HospitalZhejiang University Shool of MedicineHangzhouChina
  2. 2.Department of Pediatric Thoracic Surgery, Children’s HospitalZhejiang University Shool of MedicineHangzhouChina
  3. 3.Department of Pediatric Thoracic Surgery, Children’s HospitalZhejiang University Shool of MedicineHangzhouChina

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