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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

An upright abdominal X-ray showing marked dilatation of duodenum
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Figure 0004: An upright abdominal X-ray showing marked dilatation of duodenum

Mentions: The second unusual presentation was dysphagia and FTT (case 5). The patient was a 6-year-old girl who had been managed for esophageal stricture by multiple balloon dilatation and peptic disease medications for many years but relapsed. Eventually, plain abdomen X-ray had shown “double bubble” appearance and barium meal recommended duodenal atresia in “wind sock deformity” type (Figures 4 and 5).


Congenital duodenal obstruction with delayed presentation: seven years of experience
An upright abdominal X-ray showing marked dilatation of duodenum
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0004: An upright abdominal X-ray showing marked dilatation of duodenum
Mentions: The second unusual presentation was dysphagia and FTT (case 5). The patient was a 6-year-old girl who had been managed for esophageal stricture by multiple balloon dilatation and peptic disease medications for many years but relapsed. Eventually, plain abdomen X-ray had shown “double bubble” appearance and barium meal recommended duodenal atresia in “wind sock deformity” type (Figures 4 and 5).

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