The outcome of congenital duodenal obstruction in infancy in Erbil

Abstract

Background and objective: Duodenal atresia and stenosis is considered a frequent cause of intestinal obstruction in the newborn, good prenatal work up and investigation make early diagnosis and better prognosis. This study aimed to evaluate the prenatal diagnosis, types, post-delivery management, associated anomalies, operative management and outcomes in neonates with congenital duodenal obstruction. Methods: A prospective study including 21 infants (13 female and eight male) with congenital duodenal obstruction were treated at Rapareen Teaching Hospital in Erbil from December 2011 to December 2015. Results: The mean age at presentation was 8.1 days (range 4 to 52 days), and the mean weight was 2.63 kilogram. Around 95% were term and 61.9% of patients delivered through cesarean section. The commonest presentation was bilious vomiting in 95.2% of cases. Associated anomalies were present in six cases in particular Down’s syndrome in five cases. Plain abdominal x-ray, ultrasound of abdomen and echocardiography done for all cases while upper gastrointestinal contrast study was done only in 5 cases. All managed operatively through laparotomy, and diamond shaped duodenoduodenostomy was the main procedure done in 17 cases, web resection in two cases, Ladd's procedure in one case and duodenojejunostomy in one case. The survival was 95.2%. Conclusion: Congenital duodenal obstruction is a common condition facing the pediatric surgeon. Associated anomalies is the first factor influencing the outcome. The most common causes of congenital duodenal obstruction were atresia, and annular pancreas and the most important warning sign is the bile stained vomiting. Treatment should be expedient and concurrent with ongoing resuscitation.