Congenital Duodenal Obstruction in Neonates: Over 13 Years’ Experience from a Single Centre

Abstract

Aim: To study the prevalence of associated anomalies with neonatal duodenal obstruction and factors impacting short-term survival. Material and methods: Records of 31 neonates with neonatal duodenal obstruction could be retrieved and analyzed for a 13.5-year-period (October 2003-May 2016). M:F ratio was 1.58:1. The mean birth weight was 2.15 kg; 12 patients were preterm. Etiologies included duodenal atresia (n=23), duodenal web (n=8) and malrotation of gut (n= 6). Results: Associated anomalies were seen in 19/31: Down's syndrome (n=6), anorectal malformation (ARM) (n=5), annular pancreas (n=5), cardiac anomalies (n=4), esophageal atresia with trachea-esophageal fistula (EA with TEF) (n=3). Mortality in the series was 22.5%; 5 deaths and 2 patients left against medical advice in moribund state (hidden mortality). Mortality in associated anomalies group was 5/19; and 2/12 in the no anomalies group, though this difference was not statistically significant (p=0.676). Similarly, low birth weight (LBW) did not have impact on survival (p=0.639) but preterm status had highly significant p value (<0.001). Conclusion: Duodenal atresia was the commonest cause of neonatal duodenal obstruction. Associated anomalies were noted in 61% patients, Down's syndrome being the most frequent. These anomalies did not have any significant impact on the survival, nor did LBW. Preterm status had significant impact on prognosis.

Duodenal Obstruction in Children: An Eight Year Experience in Basrah

“…In this study, 14 patients (23.3%) were aged between 30 days and 12 months, and 2 patients (3.3%) were diagnosed after the age of one year. This study reported a male gender predilection (M:F=1.14:1), same finding was seen in Parveen Kumar et al 9 and Kamal et al studies 11 .…”

“…This study reported a mortality rate of CDO to be 11.7%, which is comparable to many studies from the developing countries, Rattan et al 20 had reported mortality of 11 (13.5%) out of 81 neonates, Parveen Kumar et al study 9 reported 22.5% mortality and Zamir et al 21 had reported mortality of 58% in a study from Pakistan. In the developed countries, antenatal diagnosis and timely intervention to correct CDO, postoperative outcome is much better than developing countries 22,23 .…”

“…Associated congenital anomalies were reported more frequently in duodenal atresia rather than malrotation patients (28.2% vs. 17.8% respectively), Chhabra et al 13 and Grosfeld et al 14 studies had reported a higher percentages of associated anomalies particularly in duodenal atresia (more than 50%), this is most likely due to more thorough prenatal and early postnatal screening program to detect even simple anomalies, this is not widely available in many pediatric surgery centers in the developing countries including ours. Down's syndrome was reported in 6 (18.8%) of duodenal atresia group, nearly a similar finding (19.35%) was reported in Parveen Kumar, et al study 9 but in Kamal et al study 11 it was only 8.6%. Congenital heart defects were more common in duodenal atresia patients in comparison with malrotation patients (6.3% and 3.6% respectively), while skeletal anomalies were reported only in duodenal atresia.…”

“…Regarding intraoperative findings, this study reported a high prevalence of duodenal web (59.4%) among patients with duodenal atresia/stenosis group, while duodenal atresia, annular pancreas, congenital duodenal stenosis and preduodenal portal vein were seen less frequently Figure (I), this differs from what was reported by many studies in which duodenal atresia was the most common finding intraoperatively, Parveen Kumar et al study 9 reported duodenal atresia in 77.4% of CDO, while Mustafawi 14 study reported duodenal web in only 19.5%. this is could be due to atypical and less acute clinical picture of fenestrated duodenal web (partial duodenal obstruction), that in turn force many general surgeons to refer those patients for pediatric surgery center rather than managing them like in cases of typical duodenal atresia, this will result in raising the proportion of duodenal web on the expense of the duodenal atresia.…”

Late diagnostics of intestinal malformation in a 3 year-old child presenting with Down syndrome

“…Синдром Дауна -это распространенная генная патология (1:650-1000), обусловливающая наличие врожденных пороков развития различных органов и систем, в том числе желудочно-кишечного тракта [1][2][3][4]. Среди пороков пищеварительной системы у больных синдромом Дауна чаще, чем в общей популяции, выявляют атрезию пищевода, стеноз и атрезию двенадцатиперстной кишки, незавершенный поворот кишечника, кольцевидную поджелудочную железу, болезнь Гиршпрунга, атрезию ануса [2][3][4][5][6].…”