Management of Congenital Duodenal Obstruction by Diamond-Shaped Duodenoduodenostomy
Keywords:Management; Congenital; Duodenal obstruction; Diamond-shaped duodenoduodenostomy
A prospective study of 20 patients with clinical diagnosis of duodenal obstruction done at pediatric surgery
center in AL Khanssa maternity and children Teaching Hospital in Mosul from December 2006-January
2010, a detailed case-record of 20 consecutive newborn patients treated for duodenal obstruction. The aims
of the study was to analyze our experience and to evaluate the clinical presentation, diagnosis, postoperative
care, and outcome in infants with duodenal obstruction.The 20 patients were classified according to
classification system modified from James A. O’Neill: duodenal web, atresia , annular pancreas and
malrotation.The presumptive diagnosis and decision regarding the need for surgery was based on clinical
findings and investigation of plain abdominal radiographs in all patients without the need of dye study.
Abdominal ultrasound examination was done for all patient to evaluate the associated renal anomalies and
echocardiogram was done for 15 patients because of suspicion of congenital heart disease.other laboratory
investigation including complete blood count, serum electrolyte, blood urea and total serum bilirubin
were done for all patients.the management strategy for all patients was outlined as follows: After initial
evaluation, a nasogastric tube (NGT) was placed for gastric decompression. The operative procedures
performed through supra umbilical transverse abdominal incision. The type of duodenal obstruction was
assessed after mobilizing the ascending and transverse colon to the left and identifying any associated
malrotation. Kocherization of duodenum then performed and a transpyloric tube was passed to determine if
a windsock abnormality was present . In duodenal atresia intraoperatively injection of saline or air into the
distal segment was done to rule out a second atresia. Using a single layer of interrupted suture with posterior
knots tied inside and anterior knots tied outside by using 5-0 or 6-0 Vicryl (polyglactin) o Polydiaxonone
suture(PDS) 5/0 to complete the anastamosis. The age of our patients were ranging from1day to 16 days
and divided in to two groups from 1 up to 7 days. The Common clinical findings in our patients were bilious
emesis, upper abdominal distension, failure to pass meconium . And accordingly the incidence of each
symptoms and signs.The available investigations in our center at any time was the plain abdominal x ray,
the finding in plain x-ray of abdomen was double bubble sign in 18(90%)of the patients and single gastric
gas shadow in 2(10%) of patient. Abdominal ultrasound examination was done for all patients locking
for any associated anomalies especially of the urinary tract. The finding was ectopic kidney in 1(5%) and
hydronephrosis in 1(5%) of our patient. Echocardiography has been performed in 15 patients , abnormal in
2 male babies one of them had VSD and another one had ASD. Careful examination and follow up locking
for associated anomalies were done and their types and percentile shows male patient have more associated
anomalies than female.
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