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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.


Barium meal shows dilated duodenum proximal to the web and multiple filling defects
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Figure 0002: Barium meal shows dilated duodenum proximal to the web and multiple filling defects

Mentions: The age of patients at operation time ranged from 5 days to 72 months (mean: 26.7 months). In the past medical history the signs and symptoms of partial intestinal obstruction had started in early infancy. Patients older than 2 years presented with major complications of gastroesophageal reflux such as gastroduodenitis, esophagitis, esophageal ulcer and stricture and FTT. We had the opportunity of being presented with a rare case of an individual who had referred to our center for management of FTT (case 4). Due to weekly non-bilious vomiting and an epigastric mass in palpation, we had taken a plain abdomen X-ray and barium meal. “Soap bubble” appearance in combination with atypical “double bubble” suggested duodenal web associated with numerous foreign bodies. During the operation, we found 440 (190 g) seeds of peach, apricot, date and palm kernel and nuts of varying sizes and a small piece of a plastic that impacted the small aperture of the diaphragm, which allowed only a 12 Fr feeding tube to pass through (Figures 2 and 3).


Congenital duodenal obstruction with delayed presentation: seven years of experience
Barium meal shows dilated duodenum proximal to the web and multiple filling defects
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: Barium meal shows dilated duodenum proximal to the web and multiple filling defects
Mentions: The age of patients at operation time ranged from 5 days to 72 months (mean: 26.7 months). In the past medical history the signs and symptoms of partial intestinal obstruction had started in early infancy. Patients older than 2 years presented with major complications of gastroesophageal reflux such as gastroduodenitis, esophagitis, esophageal ulcer and stricture and FTT. We had the opportunity of being presented with a rare case of an individual who had referred to our center for management of FTT (case 4). Due to weekly non-bilious vomiting and an epigastric mass in palpation, we had taken a plain abdomen X-ray and barium meal. “Soap bubble” appearance in combination with atypical “double bubble” suggested duodenal web associated with numerous foreign bodies. During the operation, we found 440 (190 g) seeds of peach, apricot, date and palm kernel and nuts of varying sizes and a small piece of a plastic that impacted the small aperture of the diaphragm, which allowed only a 12 Fr feeding tube to pass through (Figures 2 and 3).

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.