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

ABSTRACT

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.