Abstract
Delayed return of normal duodenal function necessitating a prolonged hospital stay may often follow operative treatment of neonatal duodenal obstruction (NDO). Previously suggested ways to improve the operative result include variations in the anastomic technique, duodenal tapering, and the omission of gastrostomy. We have analysed the experience at the Prince of Wales Children's Hospital of 30 consecutive cases of NDO treated over a 7-year period (1984–1990) in order to define factors in the treatment that might influence the establishment of oral feeding and duration of hospital stay. There were 19 males and 11 females, with duodenal atresia occurring in 10 and extrinsic or intrinsic causes of duodenal stenosis in the remaining 20. Two patients died without operation. Corrective procedures included 17 duodenoduodenostomies, 9 duodenoplasties, and 2 patients had lysis of Ladd's bands that produced duodenal obstruction from the time of birth. Only 1 patient underwent duodenal tapering. There were 20 gastrostomies performed according to the preferences of the primary-care surgeons. It was shown that the duration of establishing oral feeding and hospital stay were not influenced by the type of corrective procedure, although Ladd's bands duodenal obstruction was associated with the shortest hospital stay. The use of a gastrostomy was related to higher morbidity, a longer period to establish oral feeding, and a prolonged hospital stay. Prenatal diagnosis has also emerged as an important influencing factor. It is concluded that gastrostomy should be omitted in the treatment of NDO. The various types of corrective procedures were similar in final outcome in terms of morbidity and total hospitalisation time.
Similar content being viewed by others
References
Adzick NS, Harrison MR, deLorimier AA (1986) Tapering duodenoplasty for megaduodenum associated with duodenal atresia. J Pediatr Surg 21: 311–312
Akhtar J, Guiney E (1992) Congenital duodenal obstruction. Br J Surg 79: 133–135
Calder J (1733) Two examples of children born with preternatural conformation of the guts. Med Essay (Edinburgh) 1: 203
Danismend EN, Brown S, Frank JD (1986) Morbidity and mortality in duodenal atresia. Z Kinderchir 41: 86–88
Guiot P, Backy A (1984) 5 cases of neonatal duodenal obstruction. Acta Chir Belg 84: 273–275
Hancock BJ, Wiseman NE (1989) Congenital duodenal obstruction: the impact of an antenatal diagnosis. J Pediatr Surg 24: 1027–1031
Hummer P, Angermann B (1985) Intestinal abnormalities as a cause of ileus in the newborn infant. Lagenbecks Arch Chir 36: 209–213
Kimura K, Mukohara N, Nishijima E, Muraji T, Tsugawa C, Matsumoto Y (1990) Diamond-shaped anastomosis for duodenal atresia: an experience with 44 patients over 15 years. J Pediatr Surg 25: 977–979
Miro J, Bard H (1988) Congenital atresia and stenosis of the duodenum: the impact of a prenatal diagnosis. Am J Obstet Gynecol 158: 555–559
Mooney D, Lewis JE, Connors PH, Weber TR (1987) Newborn duodenal atresia: an improving outlook. Am J Surg 153: 347–349
Rescorla FJ, Grosfeld JL (1985) Intestinal atresia and stenosis: analysis of survival in 120 cases. Surgery 98: 668–676
Reyes HM, Meller JL, Loeff D (1989) Neonatal intestinal obstruction. Clin Perinatol 16: 85–96
Romero R, Ghidini A, Costigan K, Touloukian R, Hobbins J (1988) Prenatal diagnosis of duodenal atresia: does it make any difference? Obstet Gynecol 71: 739–741
Webb CH, Wangensteen OH (1931) Congenital intestinal atresia. Am J Dis Child 41: 262
Weber TR, Lewis JE, Mooney D, Connors R (1986) Duodenal atresia: a comparison of techniques of repair. J Pediatr Surg 21: 1133–1136
Weisgerber G, Boureau M (1982) Immediate and secondary results of duodeno-duodenostomies with tapering in the treatment of total congenital duodenal obstructions in newborn infants. Chir Pediatr 13: 369–372
Author information
Authors and Affiliations
Additional information
Correspondence to: E. Shi
Rights and permissions
About this article
Cite this article
Nerwich, N., Shi, E. Neonatal duodenal obstruction: a review of 30 consecutive cases. Pediatr Surg Int 9, 47–50 (1994). https://doi.org/10.1007/BF00176107
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00176107