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Congenital duodenal obstruction with delayed presentation: seven years of experience

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: The duodenum is the most common site for congenital intestinal obstruction. The duodenal web with a central hole can present without any overt signs of obstruction at a later age.

Material and methods: Over a 7-year period, children with congenital intestinal obstruction were identified in this study. The complications and operative findings of patients with duodenal web with conditions such as wind sock deformity and delayed diagnosis were evaluated in this study.

Results: This study included 81 infants with congenital intestinal obstruction. At operation, 48 patients demonstrated duodenal obstruction with atresia in 27, annular pancreas in 15 and malrotation in 6. Also, we observed incomplete obstruction of the duodenum due to a fenestrated web in 8 patients. The age of these patients at operation time ranged from 5 days to 72 months. Fifty percent of affected patients were associated with trisomy 21, all of whom exhibited failure to thrive due to food intolerance. The patients older than 2 years presented with major complications of gastroesophageal reflux such as esophageal ulcer, stricture and dysphagia. Additionally we had a unique case of a patient who had been referred with an epigastric mass. During the operation, we found 440 seeds of various fruits in the stomach and the first portion of the duodenum.

Conclusions: Our study emphasizes that duodenal web with a central hole can present without signs of obstruction at a later age with only failure to thrive and food intolerance. Therefore a high index of suspicion is necessary for diagnosis when it presents beyond the usual age.

No MeSH data available.


Related in: MedlinePlus

Distribution of congenital small intestinal obstruction in 81 children
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Figure 0001: Distribution of congenital small intestinal obstruction in 81 children

Mentions: This study included 81 infants with congenital intestinal obstruction. There were 37 girls and 44 boys. At operation, 48 (58.2%) patients were found with duodenal obstruction, atresia in 27 (56.2%), annular pancreas in 15 (31.25%) and malrotation in 6 (12.5%). Also, the location of atresia in 24 (29.6%) and 9 (11.1%) subjects was subsequently in the jejunum and ileum (Figure 1). One case with ileocecal valve atresia was classified in the ileal group [10]. On the other hand, 12 (14.8%) patients were premature and 8 (9.8%) had Down's syndrome. In cases with trisomy 21 the location of obstruction was in the duodenum (atresia in 7 and annular pancreas in 1 patient).


Congenital duodenal obstruction with delayed presentation: seven years of experience
Distribution of congenital small intestinal obstruction in 81 children
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016578&req=5

Figure 0001: Distribution of congenital small intestinal obstruction in 81 children
Mentions: This study included 81 infants with congenital intestinal obstruction. There were 37 girls and 44 boys. At operation, 48 (58.2%) patients were found with duodenal obstruction, atresia in 27 (56.2%), annular pancreas in 15 (31.25%) and malrotation in 6 (12.5%). Also, the location of atresia in 24 (29.6%) and 9 (11.1%) subjects was subsequently in the jejunum and ileum (Figure 1). One case with ileocecal valve atresia was classified in the ileal group [10]. On the other hand, 12 (14.8%) patients were premature and 8 (9.8%) had Down's syndrome. In cases with trisomy 21 the location of obstruction was in the duodenum (atresia in 7 and annular pancreas in 1 patient).

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: The duodenum is the most common site for congenital intestinal obstruction. The duodenal web with a central hole can present without any overt signs of obstruction at a later age.

Material and methods: Over a 7-year period, children with congenital intestinal obstruction were identified in this study. The complications and operative findings of patients with duodenal web with conditions such as wind sock deformity and delayed diagnosis were evaluated in this study.

Results: This study included 81 infants with congenital intestinal obstruction. At operation, 48 patients demonstrated duodenal obstruction with atresia in 27, annular pancreas in 15 and malrotation in 6. Also, we observed incomplete obstruction of the duodenum due to a fenestrated web in 8 patients. The age of these patients at operation time ranged from 5 days to 72 months. Fifty percent of affected patients were associated with trisomy 21, all of whom exhibited failure to thrive due to food intolerance. The patients older than 2 years presented with major complications of gastroesophageal reflux such as esophageal ulcer, stricture and dysphagia. Additionally we had a unique case of a patient who had been referred with an epigastric mass. During the operation, we found 440 seeds of various fruits in the stomach and the first portion of the duodenum.

Conclusions: Our study emphasizes that duodenal web with a central hole can present without signs of obstruction at a later age with only failure to thrive and food intolerance. Therefore a high index of suspicion is necessary for diagnosis when it presents beyond the usual age.

No MeSH data available.


Related in: MedlinePlus