Prenatal Detection of Congenital Duodenal Obstruction—Impact on Postnatal Care

Abstract

Background: Duodenal obstruction is a rare cause of congenital bowel obstruction. Prenatal ultrasound could be suggestive of duodenal atresia if polyhydramnios and the double bubble sign are visible. Prenatal diagnosis should prompt respective prenatal care, including surgery. The aim of this study was to investigate the rate and importance of prenatally diagnosed duodenal obstruction, comparing incomplete and complete duodenal obstruction. Methods: A retrospective, single-center study was performed using data from patients operated on for duodenal obstruction between 2004 and 2019. Prenatal ultrasound findings were obtained from maternal logbooks and directly from the investigating obstetricians. Postnatal data were obtained from electronic charts, including imaging, operative notes and follow-up. Results: A total of 33/64 parents of respective patients agreed to provide information on prenatal diagnostics. In total, 11/15 patients with complete duodenal obstruction and 0/18 patients with incomplete duodenal obstruction showed typical prenatal features. Prenatal diagnosis prompted immediate surgical treatment after birth. Conclusion: Prenatal diagnosis of congenital duodenal obstruction is only achievable in cases of complete congenital duodenal obstruction by sonographic detection of the pathognomonic double bubble sign. Patients with incomplete duodenal obstruction showed no sign of duodenal obstruction on prenatal scans and thus were diagnosed and treated later.

Cardiac anomalies in children with congenital duodenal obstruction: a systematic review with meta-analysis

“…In total, 90 studies described trisomy 21 in 5413 patients with DO [ 1 , 10 – 12 , 14 – 26 , 28 – 30 , 32 – 67 , 69 – 76 , 78 – 89 , 91 – 95 , 97 – 103 , 105 , 106 ]. The pooled percentage of trisomy 21 was 28% (95% CI 0.262–0.308; I 2 = 66%; p < 0.001) of the patients with DO and is shown in Fig.…”

“…The following period between 2000 and 2009 included 17 studies with 970 patients and had a calculated pooled proportion of 32% percent (95% CI 0.243–0.407; I 2 = 82%; p = 0.000) [ 12 , 14 , 22 , 23 , 28 , 29 , 37 , 45 , 48 , 49 , 62 , 67 , 73 , 74 , 85 , 90 , 106 ]. The last period between 2010 and present included 47 studies with 3747 patients [ 1 , 6 , 16 , 18 – 21 , 24 – 27 , 31 , 35 , 36 , 42 , 46 , 47 , 50 , 52 , 53 , 55 , 57 – 59 , 68 , 69 , 71 , 72 , 77 , 78 , 81 – 84 , 87 , 88 , 91 – 95 , 97 , 98 , 100 , 103 – 105 ]. For this period, the pooled percentage for cardiac anomalies was 34% percent (95% CI 0.290–0.392; I 2 = 89%; p = 0.000).…”

Obstrucción intestinal por páncreas anular en etapa neonatal: reporte de caso

“…Las yemas ventrales corresponden a la parte inferior de la cabeza del páncreas y la apófisis uncinada, mientras que la yema dorsal se convierte en cola y cuerpo. El páncreas anular ocurre cuando la yema ventral no rota con el intestino, lo que provoca la envoltura del duodeno (2,4,9) . Esto da como resultado un anillo de tejido pancreático no distensible, que suele rodear la segunda porción del duodeno (5,9) .…”

“…La prevalencia exacta es desconocida, en la literatura se describe 1 caso por cada 20 000 recién nacidos vivos aproximadamente (1) . Se ha asociado con polihidramnios materno (2) y anomalías congénitas como atresia esofágica y duodenal, malformación anorrectal y divertículo de Meckel (3) . El páncreas anular puede clasificarse, según la distribución anatómica del parénquima pancreático alrededor del duodeno, en completo e incompleto (4) .…”

“…El páncreas anular completo ocurre cuando el conducto anular rodea completamente la segunda porción del duodeno (4) , mientras que el páncreas anular incompleto se da cuando el anillo se extiende en dirección posterolateral o anterolateral a la segunda porción del duodeno (4) . La edad de presentación dependerá de la gravedad de la obstrucción duodenal intrínseca (2,5) . Aproximadamente dos tercios de la población infantil lo presentan durante el periodo neonatal, y tiende a ser severa, en cuyo caso se manifiesta desde el nacimiento con vómitos típicamente biliosos y distensión abdominal (5) .…”