Congenital Duodenal Obstruction

Question 1

Congenital duodenal atresia is a congenital bowel obstruction, usually affecting what part of duodenum.

Answer 1

second part

Question 2

three types of congenital duodenal obstruction are

Answer 2

.

Question 3

Congenital duodenal obstruction is also classified into:

Answer 3

− Complete: caused by duodenal atresia or complete duodenal diaphragm

− Incomplete (Partial): caused by duodenal stenosis, duodenal diaphragm with a central hole, or extrinsic causes.

Extrinsic causes are annular pancreas , Ladd’s bands, duplication cyst, portal vein passing anterior to duodenum, etc.

Question 4

Presentation

Answer 4

recognized antenatally by the classic double bubble appearance on ultrasound and associated maternal polyhydramnios (30–65 % of cases).

Early onset of bilious vomiting and feeding intolerance

Features of trisomy 21 (Down’s syndrome).

Examination

• Upper abdominal distension or scaphoid abdomen in atresia if the stomach is empty or the child is on nasogastric drainage.
• Bilious aspirate in the nasogastric tube.

dehydration, and associated cardiac malformation.

Question 5

Associated Anomalies of congenital duodenal obstruction

Answer 5

Trisomy 21 (Down’s syndrome) → 28.2 %

• Congenital heart disease → 22.6 %
• Annular pancreas → 23.1 %
• Intestinal malrotation → 19.7 %
• Esophageal atresia/tracheoesophageal fistula

Question 6

Most common Associated Anomalies of congenital duodenal obstruction is

Answer 6

Down syndrome

Question 7

Diagnosis of congenital duodenal obstruction includes

Answer 7

A plain abdominal X-ray showing double bubble confirm the diagnosis of complete duodenal obstruction

Contrast study
The presence of a duodenal diaphragm with a central aperture is confirmed by the incomplete duodenal obstruction in absence of malrotation ( small distal bowel gas and thin contrast seen distally )

Question 8

Treatment

Answer 8

Gastric decompression is essential to prevent aspiration

Fluid resuscitation

Open surgery or laparoscopic correction of congenital duodenal obstruction can be performed.

1. A diamond-shaped duodeno-duodenostomy (as described by Kimura) or a simple duodenoduodenostomy is performed in cases of type 2 atresia and with annular pancreas.

side-to-side duodeno-jejunostomy in type 3 atresia with a wide gap or if the atresia is in the third or fourth parts of duodenum

Postoperative Care

• All infants are maintained on bowel rest and parenteral nutrition.
• Nasogastric aspirates are monitored and fluid losses are replaced

Question 9

Complications of the surgery

Answer 9

Anastomotic leak.

• Wound infection.
• Delayed gastric emptying with consequent delayed feeding