A retrospective analysis of 171 neonates with congenital duodenal obstruction / 国际儿科学杂志

Objective To investigate the incidence,clinical characteristics,diagnosis and treatment of various congenital duodenal obstruction in neonates.Methods Cases diagnosed with congenital duodenal obstruction admitted to Shengjing Hospital from 2006 to 2015 were collected.Clinical characteristics and prognosis were then analyzed.Results One hundred and seventy-one patients were included(106 males and 65 females),among which 26 were premature and 145 mature.In these patients,55 were diagnosed with duodenal atresia or stenosis,39 annular pancrea,89 midgut malrotation (70 associated with midgut volvulus),and 15 with at least two conditions above.Bile vomiting was the most common clinical manifestation.For 41.52％ of the patients,symptoms occurred within the first 24 hours after birth,and children with duodenal stenosis,duodenal atresia,or annular pancreas were significantly linked with earlier symptoms than patients with intestinal malrotation.Positive diagnosis rate of abdominal plain film,abdominal doppler ultrasonography,and upper gastrointestinal contrast were 73.10％,37.14％,and 100％,respectively,with significant difference (P ＜ 0.01).Compared with those whose first diagnosis were executed postnally,patients whose anomalies were found prenatally were diagnosed and operated significantly earlier(P ＜0.01).Postoperative fasting time and hospitalization time of patients with various malformations were significantly longer than groups with single anomaly.Among the 171 cases,162 were performed operation(9 cases abandoned treatment because of extensive intestinal necrosis),145 cases recovered well 25 quitted,and 1 died,with a cure rate of 94.77 ％.Postoperative short-term complications included incision infection,unwound,intestinal perforation and anastomotic fistula.Conclusion The causes of congenital duodenal obstruction include duodenal atresia or stenosis,annular pancreas and congenital intestinal malrotation,among which congenital intestinal malrotation is most common.A higher incidence was seen in male infants.The onset of symptoms is seen later in intestinal malrotation.The positive diagnosis rate of upper gastric contrast study is highest.The recovery process for patients diagnosed prenatally is not better than patients diagnosed after birth.Patients with multiple malformations need more time to cure.The prognosis is excellent in most cases.

Colangiografía oral y la atresia duodenal / Oral cholangiography and duodenal atresia

Se presenta el caso de un recién nacido masculino con síndrome de Down, que presentó al nacimiento vómito biliar y al examen físico ictericia y hepatomegalia leve. Los estudios radiológicos simple de abdomen y la serie gastrointestinal mostraron al duodeno dilatado y cambios inflamatorios de la mucosa. Esta imagen es conocida como la imagen en “doble burbuja” y es común en la obstrucción duodenal congénita. Simultáneamente fueron visualizados la vesícula biliar y el colédoco, siendo este hallazgo poco usual. Se le efectuó corrección del defecto mediante el procedimiento de Kimura.

A newborn male patient with trisomy-21 presented with bilious hemesis. The patient was icteric with slight hepatomegaly. Simple abdominal X-ray and upper gastrointestinal series with barium showed a dilated duodenal loop and inflammatory changes involving the duodenal mucosa. This image known as [quot ]double bubble[quot ] is characteristic of congenital duodenal obstruction. Simultaneously the gallbladder and choledochus were visualized. The former X-ray finding is very unusual. An uneventful Kimura procedure was performed.

Effectiveness of Laparoscopic Sutured Anastomosis of the Duodenum in Children / 中国微创外科杂志

Objective To evaluate the effectiveness of laparoscopic sutured anastomosis of the duodenum for children with congenital duodenal obstruction (CDO). Methods From February 2003 to July 2008,13 patients (aged 2 days to 12 years) with CDO underwent laparoscopic sutured anastomosis of the duodenum in our hospital. Among the cases,7 were newborns,3 were infants,and 3 were children. Laparoscopy showed duodenal atresia or stenosis in 7 cases,annular pancreas in 2 cases,superior mesenteric artery syndrome (SMAS) in 3 cases,and preduodenal portal vein in 1 case. Results Excepting the patient with preduodenal portal vein,who was converted to mini-laparotomy for duodenojejunostomy,all the cases were treated by laparoscopy. In 5 cases,the diaphragm was excised partially after a vertical incision was made at the anterior part of the duodenum,and then a transverse suture was completed; the 2 patients with duodenal atresia and the 2 with annular pancreas received diamond-shaped side-to-side duodenoduodenal anastomosis under a laparoscope; and the 3 cases of SMAS were treated by Roux-en-Y duodenojejunostomy. The mean operation time in this series was (97.0?18.2) min (range,75 to 180 min). No intraoperative complications occurred. The patients started oral intake in 2 to 5 days after the surgery,and resume a normal diet in 7 to 9 days. Before being discharged from the hospital,upper gastrointestinal tract imaging showed no evidence of obstruction in the patients.A follow-up up to 6 months to 4 years were available in 11 patients,among which 8 were followed for more than 1 year. During the period,the patient developed well. Conclusions The laparoscopic sutured anastomosis of the duodenum is feasible and effective for children. It can be performed in neonates securely as an excellent minimally invasive treatment for congenital duodenal obstruction.