Diagnosis Of Congenital Duodenal Obstruction Research Articles

Novel qualitative and quantitative ultrasound markers to facilitate prenatal diagnosis of congenital duodenal obstruction

Objective Accurate prenatal diagnosis of congenital duodenal obstruction (CDO) is challenging. We aimed to determine new ultrasound metrics for accurate prenatal diagnosis of fetal CDO. Methods Data pertaining to 46 fetuses with suspected small intestinal obstruction (26 CDO; 16 high jejunal obstructions) were retrospectively analyzed. Prenatal ultrasonographic features including dilated intestinal length, stomach length, maximum intestinal dilatation, ratio of dilated intestinal length at late gestation and dilated stomach length (I/S ratio), and location of distal end of dilated bowel segment relative to spine were compared between CDO and high jejunal obstruction groups. The diagnostic performance of ultrasound indices was evaluated using receiver operating characteristics curve analysis. Results In 25 out of 26 CDO cases, the distal end of the dilated small intestine segment was located on the right side of spine, while that in the high jejunal obstruction group was located on the left side of spine. The dilated intestinal length and I/S ratio in CDO group were significantly smaller than those in high jejunal obstruction group (p < .05). Dilated intestinal length <51 mm or I/S ratio <1 showed high sensitivity (100, 100%) and specificity (96.1, 92.3%) for CDO (area under the curve: 0.995 and 0.988, respectively). There were no significant differences in the AUCs of dilated intestinal length and I/S ratio. Significant correlation of the site of obstruction in CDO with fetal dilated intestinal length and I/S ratio (r = 0.686; 0.660, p < .001, respectively) were noted. Conclusion Location of the distal end of the dilated small intestine segment relative to the spine, dilated intestinal length, and I/S ratio may help differentiate fetal CDO from high jejunal obstruction. The latter two metrics were associated with the site of obstruction in CDO patients.

Prenatal Detection of Congenital Duodenal Obstruction-Impact on Postnatal Care.

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.

The application of prenatal ultrasound in the diagnosis of congenital duodenal obstruction

BackgroundThe purpose of this research is to summarize the prenatal ultrasound characteristics of congenital duodenal obstruction (CDO), especially in the diagnosis of duodenal diaphragm and annular pancreas. At present, few researchers have summarized the specific ultrasound features of duodenal diaphragm and annular pancreas.MethodsIn this study, a retrospective analysis of 40 patients diagnosed with CDO between January 2016 and December 2019 was carried out. Data on the diagnosis, ultrasound images and outcomes of the patients were gathered, and the features of the patients were analyzed.ResultsThe results showed that there were 17 patients (42.5%) of congenital duodenal diaphragm, all with a ‘rat tail’ sign on the ultrasound images. Moreover, there were 4 patients (10.0%) of CDO caused by annular pancreas, all with a ‘pliers’ sign on the ultrasound images. We summarized the imaging features of the ‘rat tail’ sign and the ‘pliers’ sign.ConclusionThe main conclusion of this study was that the ‘rat tail’ sign could be used as an indirect ultrasound feature to diagnose duodenal diaphragm. The ‘pliers’ sign could be used as a direct ultrasound feature in the diagnosis of annular pancreas in CDO.

Enhanced recovery after surgery for the treatment of congenital duodenal obstruction

BackgroundEnhanced recovery after surgery (ERAS) has been widely used in adult surgery. However, ERAS has not been reported in neonatal surgery. The present prospective study explored the application value of ERAS in treating congenital duodenal obstruction (CDO). MethodsA total of 68 cases of CDO were collected from October 1, 2017 to July 31, 2019. We divided patients with a prenatal diagnosis of congenital duodenal obstruction into the ERAS group and those who were diagnosed the disease after birth into the control group. The ERAS group adopted ERAS-related measures, and the control group followed the usual measures. The study compared the differences in the gestational age, birth weight, length of hospital stay (LOS), complications, feeding intolerance, and weight one month after surgery between the two groups. ResultsA total of 49 patients were included in the analysis, including 23 who were allocated to the ERAS group and 26 to the control group. The LOS was 9.696±1.222 days in the ERAS group and 12.654±1.686 days in the control group, resulting in a significantly shorter LOS in the ERAS group than in the control group (p<0.001). One month after surgery, the neonates in the ERAS group weighted significantly more than those in the control group. No differences were observed in birth weight, gestational age, and the incidence of complications or feeding intolerance between the two groups. ConclusionIn this single-center study, the implementation of neonate-specific ERAS for CDO surgery was feasible and safe and led to a shorter LOS without increasing the incidence of complications or feeding intolerance. Type of studyTreatment Study Level of evidenceLevel III

Preduodenal Portal Vein (PDPV): A Very Rare Cause of Duodenum Obstruction

Congenital duodenal obstruction (CDO) is one of the most common anomalies presented in the neonatal period of intestinal obstruction, with an incidence of 1:10,000, and Preduodenal Portal Vein (PDPV) is a rare extrinsic cause of CDO. PDPV leads to CDO with a persistent vomiting, impairment of the oral feeding and weight loss, but other publications state an asymptomatic disease that may requires late surgical correction. Prenatal diagnosis of CDO, including PDPV, is evidenced by association of polyhydramnios with a dilated fluid-filled gastric and duodenum and a double-bobble image in the ultrasonography and permits a proper management of associated malformation, delivery, surgery and allows family counseling. PDPV is commonly associated to other intestinal obstruction such as extrinsic (annular pancreas, adhesive bands, malrotation, peritoneal bands, intestinal duplication), and intrinsic (atresia, web and stenosis), and also associated with cardiovascular anomalies, situs inversus, Down’s syndrome and polysplenia. This is full term 5 days old newborn, 2865 g girl, without prenatal diagnosis of CDO. It was not still established PDPV until surgery procedure such as Duodenoduodenostomy (Diamond-Shape) and can guide Paediatric Surgeons that face high intestinal obstruction in the neonate with or without prenatal diagnosis. In the ambulatory follow up after 4 months, baby has developed very well, in breast-feeding associated with formula-feeding with a normal weight gain (average of 550 g/month).

Diagnosis of congenital duodenal obstruction in children with high frequency ultrasound combined with gastrointestinal filling

Objective To investigate the diagnostic value of high frequency color Doppler ultrasound combined with gastrointestinal filling in infants with duodenal obstruction. Methods One hundred infants who were suspected with duodenal obstruction underwent both gastrointestinal ultrasound and upper gastrointestinal tract, put the surgical results as thegold standard, the values of ultrasonic and upper gastrointestinal tract in the diagnosis of pediatric congenital duodenal obstruction were compared. Results The diagnostic accuracy of ultrasound and upper gastrointestinal tract in duodenal obstruction was 100% and 94% respectively, the difference was statistically significant (P=0.041). The accuracy rate of obstruction location was 98.04% and 84.31% respectively, also was considered to denote statistical significance (P=0.023). The total diagnostic accuracy of congenital disorders caused by duodenal obstruction was 89% and 49% respectively, and P=0.001 implies statistically significant difference. Conclusions There is a high diagnostic accuracy in high frequency ultrasound combined with gastrointestinal filling in children with congenital duodenal obstruction, and the diagnosis of some diseases is better than that of the upper gastroenterography. Key words: Ultrasonography; Duodenal obstruction; Child

Congenital Duodenal Obstruction in Children: a Decade's Experience

Congenital duodenal obstruction (CDO) is one of the most common anomalies in newborns and infants. In 38-55% of patients, intrinsic duodenal obstruction is associated with another significant congenital anomaly. We report on a retrospective study of all children born with CDO presented to our institution over a 10-year period. A retrospective analysis was carried out of the records of all children admitted to our center from January 1996 to December 2005 with the diagnosis of congenital duodenal obstruction. Seventy-seven patients were enrolled in the study. Age ranged from 1 day to 3 months; there were 44 males and 33 females. Weight ranged from 800 g to 4.5 kg. Five babies (6.49%) were born prematurely between 31 and 34 weeks' gestation. For the purposes of comparison, duodenal obstruction was divided into 3 groups according to the intraoperative findings. The follow-up period ranged from 6 months to 5 years. The collected data were tabulated, compared, and statistically analyzed. Patients were divided into 3 groups: group 1 (duodenal atresia) consisted of 32 patients, group 2 (annular pancreas) consisted of 30 patients and group 3 (duodenal web) consisted of 15 patients. Twenty-five patients (32.4%) were diagnosed with pure duodenal obstruction, while 52 cases (67.5%) had other associated anomalies. Cardiac anomalies, Down syndrome, GIT anomalies and renal anomalies were the most commonly occurring associated anomalies. Congenital duodenal obstruction repair can have a very good outcome, as our study shows. Associated congenital cardiac, GIT, and respiratory anomalies were the main cause of postoperative morbidity. Down syndrome did not influence morbidity. Mortality was unrelated to duodenal obstruction.

Clinical Study of Congenital Duodenal Obstruction

Successful management of duodenal obstruction in newborn infant implies not only satisfactory nutrition but also achievement of normal growth. To aid early diagnosis and management, we evaluated the diagnostic methods, operative interventions and clinical characteristics of thirty-nine infants with congenital duodenal obstructions. In the 11-year period from July 1986 through June 1997, thirty-nine patients with congenital duodenal obstruction (23 males and 16 females) were treated and reviewed at the Department of Pediatric Surgery, Yeungnam University Hospital. The ratio of male to female was 1.4:1, and 29 cases(74.1%) among total 39 patients were newborn. There were 5 premature patients and 16 patients of small for gestational age. The most common causes of the congenital duodenal obstruction was malrotation (26 cases, 66.7%) and followed by annular pancreas (9 cases, 23.1 %), type 1 atresia (3 cases, 7.7%) and wind-sock anomaly (1 case, 2.6%). Common symptoms were vomiting, abdominal distention, jaundice. Plain abdominal X-ray study combined with upper gastrointestinal series was the most commonly used diagnostic method. The operative procedures were performed by same pediatric surgeon utilizing Ladd's procedure in 26, duodenoduodenostomy in 8, duodenojejunostomy in 4, excision of wind-sock membrane in 1. A total of 15 associated congenital anomalies were found in 9 patients. Postoperative complications occurred in 13(33.3%). Overall mortality was 2.6%(1/39). Bilious vomiting and plain abdominal radiologic study were most useful for the diagnosis of congenital duodenal obstruction. Early diagnosis and operative intervention were important to prevent complications such as sepsis and peritonitis.