Duodenal atresia (original) (raw)
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Operative management of duodenal atresia
Pediatric Surgery International, 1995
The management of duodenal atresia (DA) in two Scandinavian pediatric centers is reported. A total of 67 infants with DA were retrospectively analyzed. A high incidence of associated anomalies was present, including Down's syndrome in 40% and cardiac anomalies in 20% of the infants. No immediate postoperative mortality was noted. The operative procedures were duodenoduodenostomy and duodenojejunostomy. Follow-up did not disclose any frequent gastrointestinal disturbances or differences in postoperative complications when the two procedures were compared. The prognosis for these patients is thus determined exclusively by the presence of associated anomalies, especially Down's syndrome and cardiac malformations.
Duodenal atresia and stenosis: long-term follow-up over 30 years
Journal of Pediatric Surgery, 2004
Background: Duodenal atresia and stenosis is a frequent cause of congenital, intestinal obstruction. Current operative techniques and contemporary neonatal critical care result in a 5% morbidity and mortality rate, with late complications not uncommon, but unknown to short-term follow-up.
Intestinal atresia: management problems in a developing country
Pediatric Surgery International, 2004
Intestinal atresia ranks as the second most common cause of neonatal intestinal obstruction (after anorectal malformation) in our hospital. Five children had duodenal obstruction (two atresia, two duodenal webs, one annular pancreas), 17 had jejunoileal atresia, and two had colonic atresia. Fourteen were boys, and 10 were girls (M:F: 1.17:1). The median age at presentation to the surgeon was 6 days (range: 1 day-12 years). The most common presenting features were bilious vomiting and abdominal distension. Six patients did not pass meconium within the first 24 h of birth. The median weight at presentation was 2.6 kg (range: 1.1 kg-5.0 kg). Seven patients (four with jejunoileal atresia and three with duodenal obstruction) had associated congenital anomalies. Diagnostic investigation was plain abdominal x-ray, showing doublebubble gas shadows in duodenal atresia and varying degrees of air-fluid levels in jejunoileal and colonic atresias. An upper gastrointestinal series was done in three patients and a barium enema in one. Retrocolic duodenojejunostomy was done for all patients with duodenal atresia and annular pancreas, duodenotomy and web excision for those with duodenal webs, and resection with end-to-end anastomosis for those with jejunoileal atresia. One child with atresia involving the whole ileum and the colon had a jejunorectal anastomosis, while the other child with colonic atresia had caecostomy followed later by ileorectal anastomosis. Ten neonates died, giving a mortality rate of 41.7%. Mortality from intestinal atresia is still high in our environment, due mainly to lack of neonatal intensive care facilities.
Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan, 2020
Duodenal atresia is a congenital emergency abnormality and the most common cause of proximal bowel obstruction in neonates. The duodenum has not developed properly in embryogenesis with a blind end that cannot be seen through gastric contents. The incidence of duodenal atresia is 1/10.000 live births that commonly affects boys than girls. In cases of neonatal bilious vomiting, the first choice imaging modality is plain abdominal radiography. The purpose of this case report is to increase radiologist and pediatrician awareness in duodenal atresia diagnosis through plain abdominal radiography and to minimize radiation in the neonates. We report 3 cases of duodenal atresia found in Sanglah Hospital, Denpasar, in 1 year for the period 2018-2019.Case 1: A 4-day-old baby girl presented with bilious vomiting in the first 24 hours after birth.Case 2: A 4-day-old baby boy presented with lethargy, weak crying, and groaning after birth. There is no history of passed meconium in the first 24 hours of birth. Case 3: A newborn boy presented with bilious emesis after breastfeeding and nonprojectile. From the 3 cases, a plain abdominal radiograph was examined, and a double bubble sign with no intestinal gas distal was found.
Colonic atresia: surgical management and outcome
Pediatric Surgery International, 2001
Colonic atresia (CA) is a very rare cause of intestinal obstruction, and little information has been available about the management and predictors of outcome. A retrospective clinical trial was performed to delineate the clinical characteristics of CA with special emphasis on surgical treatment and factors aecting outcome. Children with CA who were treated in our department between 1977 and 1998 were reviewed: 14 boys and 4 girls aged 1 day to 5 months. All but 2 referred patients and 1 with prenatal diagnosis presented with intestinal obstruction. Plain abdominal X-ray ®lms showed ®ndings of intestinal obstruction in 14 cases; a barium enema demonstrated a distal atretic segment and microcolon in 4. The types of atresia were IIIa (n 9), I (n 6), and II (n 3). Type IIIa atresias were located proximal to the splenic¯exure (n 8) and in the sigmoid colon (n 1), type I atresias were encountered throughout the colon; and all type II atresias were proximal to the hepatic¯exure. Associated anomalies were multiple small-intestinal atresias (MSIA) (n 4), gastroschisis (GS) (n 2), pyloric atresia (n 1), Hirschsprung's disease (n 1), and complex urologic abnormalities (n 1). The initial management was an enterostomy in 15 patients (83%), including 2 referred and 2 with GS, and primary anastomosis in the remaining 3 (17%). Secondary procedures were the Santulli operation (n 2), colostomy closure and recolostomy followed by a Swenson operation (n 1), sacroabdominoperineal pull-through (n 1), and colostomy closure (n 1). Leakage was encountered in all primarily anastomosed patients. The overall mortality was 61%. Deaths occurred in patients with associated major anomalies (GS 2, MSIA 3, pyloric atresia 1) (55%) and in 3 patients who were initially managed by primary anastomosis (27%). Two additional patients died of sudden infant death syndrome (18%). Type I atresia was more common than in previously reported series and was associated with proximal multiple atresias. The initial management of CA should be prompt decompression of the intestine by an ostomy procedure, preferably end-or double-barrel. The type of surgery (primary anastomosis without prior colostomy) and associated abnormalities are the major determinants of poor outcome.
Dealing with the hugely ectatic duodenum in high jejunal atresias
Annals of Pediatric Surgery, 2014
High jejunal atresias may be associated with ectasia of the duodenum and dysmotility, which can delay inception of feedings and inanition. The procedures used for ectatic jejunum cannot be applied to the duodenum because of its complex anatomy. Dealing with the problem does not find mention in the major text books. Detailed here is a baby operated for jejunal atresia in which the ectatic duodenum led to prolonged, high postoperative aspirates, which precluded feeds. The successful operative management of the dilated duodenum is described below.
Jejuno-ileal atresia: A 2-year preliminary study on presentation and outcome
Nigerian Journal of Clinical Practice, 2012
Background/Aim: Intestinal atresia is a common cause of neonatal intestinal obstruction. Jejuno-ileum is the commonest site of intestinal atresia. Reports on Jejunoileal atresia in developing countries are still few. The purpose of this study is to determine the presentation and management outcomes of neonates with Jejunoileal atresia treated in our hospital. Materials and Methods: Detailed data on all babies that presented and were treated within the study period (November2008-November, 2010) were kept and analyzed. A management protocol was put up and maintained. Result:A total of 9 babies (7males and 2 females) were treated. They were aged 2hours to 13days. Their weight ranged from 1.7kg to 3.3kg. Apart from one baby which presented within 2hrs with prenatal ultrasound diagnosis, others had bilious vomiting from the first day of birth, abdominal distension and delayed or absent passage of meconium. Even though symptoms developed on the first day of birth, presentation to the surgical unit was delayed 72hours and beyond in most patients.Type I atresia is commonest (no=4).There is associated gut malrotation in 2 babies. Five babies had complications which included surgical site infection, sepsis, prolonged vomiting post operatively, aspiration, rupture of dilated proximal segment after membrane excision, entero-cutaneous fistula and malnutrition. Three babies died giving a mortality of 33.3%. Mortality is commoner in types IIIb and IV. Conclusion: Mortality is higher in complex atresia which most times will require neonatal intensive care and parenteral nutrition facilities. These are still lacking in our institution. Providing these facilities will further improve outcome.