Congenital duodenal obstruction: A 32-year review

Patrick V. Bailey, Thomas Tracy, Robert H. Connors, David P. Mooney, J. Eugene Lewis, Thomas R. Weber

Research output: Contribution to journalReview article

117 Citations (Scopus)

Abstract

Although survival in infants, with congenital intestinal obstruction has improved, duodenal obstruction continues to present unique challenges. One hundred thirty-eight newborns and infants (aged 0 to 30 days) were treated for congenital duodenal obstruction. Sixty-five were boys and 73 were girls. Sixty-one (45%) were premature. Forty-six had an intrinsic defect (atresia, web, stenosis, or duplication), 64 had an extrinsic defect (annular pancreas or malrotation with congenital bands), while 28 had various combinations of these. Presenting signs included vomiting (90%, bilious in 66%), abdominal distention (25%), dehydration (24%), and weight loss (17%). Although plain film abdominal x-ray was diagnostic in 58%, upper and/or lower gastrointestinal contrast studies were obtained in 71% of infants to confirm diagnosis. Thirty-eight percent of patients had associated anomalies, including Down's syndrome (11%), cardiac defects, other atresia, other trisomy syndromes, imperforate anus, and central nervous system anomalies. Fourteen patients (10%) had 3 or more other anomalies, many of which required additional surgical therapy. The operative repair of the various defects included Ladd's procedure for malrotation (31%(, duodenoduodenostomy (14%), duodenojejunostomy (22%), gastrojejunostomy or gastroduodenostomy (4%), excision of the web and duodenoplasty (3%), or combination of the above (22%). Gastrostomy was placed in 61%. One hundred twenty-eight patients survival (93%). The causes of death were combinations of sepsis, pneumonia, brain hemorrhage, short bowel, and cardiac anomaly. Eight of 10 (80%) who died had other serious anomalies. Twenty patients (14%) required reoperation 5 days to 4 years postoperatively for obstructing lesions (5), wound dehiscence (3), anastomotic leak or dysfunction (6), other atresias (2), choledochal cyst (1), pyloric stenosis (1), and gastroesophageal reflux (2). Parenteral nutrition has been used effectively for the past 15 years. Duodenal obstruction of the newborn is frequently complicated by prematurity, other associated anomalies, and nutritional compromise postrepair. However, survival of 93% is possible with aggressive, timely operative management and postoperative nutrition support.

Original languageEnglish (US)
Pages (from-to)92-95
Number of pages4
JournalJournal of pediatric surgery
Volume28
Issue number1
DOIs
StatePublished - Jan 1 1993

Fingerprint

Duodenal Obstruction
Survival
Newborn Infant
Pyloric Stenosis
Imperforate Anus
Nervous System Malformations
Choledochal Cyst
Anastomotic Leak
Gastrostomy
Gastric Bypass
Intracranial Hemorrhages
Intestinal Obstruction
Trisomy
Parenteral Nutrition
Motion Pictures
Gastroesophageal Reflux
Down Syndrome
Reoperation
Dehydration
Vomiting

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Bailey, P. V., Tracy, T., Connors, R. H., Mooney, D. P., Lewis, J. E., & Weber, T. R. (1993). Congenital duodenal obstruction: A 32-year review. Journal of pediatric surgery, 28(1), 92-95. https://doi.org/10.1016/S0022-3468(05)80364-1
Bailey, Patrick V. ; Tracy, Thomas ; Connors, Robert H. ; Mooney, David P. ; Lewis, J. Eugene ; Weber, Thomas R. / Congenital duodenal obstruction : A 32-year review. In: Journal of pediatric surgery. 1993 ; Vol. 28, No. 1. pp. 92-95.
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Bailey, PV, Tracy, T, Connors, RH, Mooney, DP, Lewis, JE & Weber, TR 1993, 'Congenital duodenal obstruction: A 32-year review', Journal of pediatric surgery, vol. 28, no. 1, pp. 92-95. https://doi.org/10.1016/S0022-3468(05)80364-1

Congenital duodenal obstruction : A 32-year review. / Bailey, Patrick V.; Tracy, Thomas; Connors, Robert H.; Mooney, David P.; Lewis, J. Eugene; Weber, Thomas R.

In: Journal of pediatric surgery, Vol. 28, No. 1, 01.01.1993, p. 92-95.

Research output: Contribution to journalReview article

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AU - Bailey, Patrick V.

AU - Tracy, Thomas

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AU - Weber, Thomas R.

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N2 - Although survival in infants, with congenital intestinal obstruction has improved, duodenal obstruction continues to present unique challenges. One hundred thirty-eight newborns and infants (aged 0 to 30 days) were treated for congenital duodenal obstruction. Sixty-five were boys and 73 were girls. Sixty-one (45%) were premature. Forty-six had an intrinsic defect (atresia, web, stenosis, or duplication), 64 had an extrinsic defect (annular pancreas or malrotation with congenital bands), while 28 had various combinations of these. Presenting signs included vomiting (90%, bilious in 66%), abdominal distention (25%), dehydration (24%), and weight loss (17%). Although plain film abdominal x-ray was diagnostic in 58%, upper and/or lower gastrointestinal contrast studies were obtained in 71% of infants to confirm diagnosis. Thirty-eight percent of patients had associated anomalies, including Down's syndrome (11%), cardiac defects, other atresia, other trisomy syndromes, imperforate anus, and central nervous system anomalies. Fourteen patients (10%) had 3 or more other anomalies, many of which required additional surgical therapy. The operative repair of the various defects included Ladd's procedure for malrotation (31%(, duodenoduodenostomy (14%), duodenojejunostomy (22%), gastrojejunostomy or gastroduodenostomy (4%), excision of the web and duodenoplasty (3%), or combination of the above (22%). Gastrostomy was placed in 61%. One hundred twenty-eight patients survival (93%). The causes of death were combinations of sepsis, pneumonia, brain hemorrhage, short bowel, and cardiac anomaly. Eight of 10 (80%) who died had other serious anomalies. Twenty patients (14%) required reoperation 5 days to 4 years postoperatively for obstructing lesions (5), wound dehiscence (3), anastomotic leak or dysfunction (6), other atresias (2), choledochal cyst (1), pyloric stenosis (1), and gastroesophageal reflux (2). Parenteral nutrition has been used effectively for the past 15 years. Duodenal obstruction of the newborn is frequently complicated by prematurity, other associated anomalies, and nutritional compromise postrepair. However, survival of 93% is possible with aggressive, timely operative management and postoperative nutrition support.

AB - Although survival in infants, with congenital intestinal obstruction has improved, duodenal obstruction continues to present unique challenges. One hundred thirty-eight newborns and infants (aged 0 to 30 days) were treated for congenital duodenal obstruction. Sixty-five were boys and 73 were girls. Sixty-one (45%) were premature. Forty-six had an intrinsic defect (atresia, web, stenosis, or duplication), 64 had an extrinsic defect (annular pancreas or malrotation with congenital bands), while 28 had various combinations of these. Presenting signs included vomiting (90%, bilious in 66%), abdominal distention (25%), dehydration (24%), and weight loss (17%). Although plain film abdominal x-ray was diagnostic in 58%, upper and/or lower gastrointestinal contrast studies were obtained in 71% of infants to confirm diagnosis. Thirty-eight percent of patients had associated anomalies, including Down's syndrome (11%), cardiac defects, other atresia, other trisomy syndromes, imperforate anus, and central nervous system anomalies. Fourteen patients (10%) had 3 or more other anomalies, many of which required additional surgical therapy. The operative repair of the various defects included Ladd's procedure for malrotation (31%(, duodenoduodenostomy (14%), duodenojejunostomy (22%), gastrojejunostomy or gastroduodenostomy (4%), excision of the web and duodenoplasty (3%), or combination of the above (22%). Gastrostomy was placed in 61%. One hundred twenty-eight patients survival (93%). The causes of death were combinations of sepsis, pneumonia, brain hemorrhage, short bowel, and cardiac anomaly. Eight of 10 (80%) who died had other serious anomalies. Twenty patients (14%) required reoperation 5 days to 4 years postoperatively for obstructing lesions (5), wound dehiscence (3), anastomotic leak or dysfunction (6), other atresias (2), choledochal cyst (1), pyloric stenosis (1), and gastroesophageal reflux (2). Parenteral nutrition has been used effectively for the past 15 years. Duodenal obstruction of the newborn is frequently complicated by prematurity, other associated anomalies, and nutritional compromise postrepair. However, survival of 93% is possible with aggressive, timely operative management and postoperative nutrition support.

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