Congenital Duodenal Stenosis: Early and Late Presentation
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- Category: Vol. 81, September 2013
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Congenital Duodenal Stenosis: Early and Late Presentation, IBRAHIM A. IBRAHIM and AL MOUTAZ A. EL TAYEB
Abstract
Background/Purpose: Congenital duodenal obstruction is a frequent cause of intestinal obstruction in the newborn. The incomplete nature of the obstruction in duodenal stenosis results in a variable and often delayed presentation. It usually results in recurrent episodes of vomiting, aspiration, or failure to thrive. Some patients present in adulthood with gastroe-sophageal reflux, peptic ulceration, or obstruction of the duodenum proximal to the stenosis by a bezoar.
The Aim of this Study: Is to report children with congenital duodenal stenosis treated at our pediatric surgery unit, to find out the factors affecting the delyed presentation and its effect upon the prognosis and to describe the management and outcome of those patients.
Material and Methods: Over a 5 years period, 13 patients with congenital duodenal stenosis were treated at pediatric surgery unit, Assiut university children hospital. There were 6 males and 7 females. 4 patients presented the 1st month after birth, 9 cases presented the following months.
Results: 13 patients were operated upon. 5 patients had associated anomalies, 2 patients had malrotation, one patient had Down's syndrome, patent foramen ovate and PDA. One patient had inguinal hernia and one patient had polydactyl. We used duodenoplasty, joining the bowel just proximal and distal to the obstruction with excision of the duodenal mem-brane The mean operative time was 55 minutes. Most patients passed stool within 24 hours and started oral feeding within 2-3 days and discharged within one week.
Conclusion:
•Duodenal stenosis can present in neonares, infants, children and even adults.
•A neonate with repeated bilious vomiting should be investi-gated as a duodenal obstruction till proved otherwise.
•Early presenting cases of duodenal stenosis resembles duodenal atresia.
•Latespresentation occurs due to incomplete nature of the obstruction, negligence of parents or unexpectancy of the diagnosis.
•In patients with malrotation, duodenal stenosis, as an asso-ciation, should be excluded.
•Duodenal stenosis could be treated surgically by duodeno-plasty either open or laparoscopic or endoscopic by dilatation or diaphragm excision.
•Duodenoplasty for duodenal stenosis is easier than duoden-oduodenostomy for duodenal atresia.