Operative and postoperative management of congenital duodenal obstruction: a 10-year experience

Forty-five patients with congenital duodenal obstruction aged from 1 day to 11 months were operated upon during the last decade. Group A included 25 neonates with duodenal obstruction due to atresia type I or a complete diaphragm in 10 cases, atresia type II in 3, atresia type III in 1, stenosis or incomplete diaphragm in 4, annular pancreas in 6, and aberrant vessels in 1. Seven duodenoduodenostomies (D-D) were performed, 14 duodenoplasties (D-P) with occasional excision of the diaphragm, and 4 duodenojejunostomies (D-J). Tapering, plication of the proximal duodenum, or gastrostomy was not performed in any child and no transanastomotic tube was placed. Group B included 20 infants with duodenal obstruction due to peritoneal bands and associated malrotation. They all underwent Ladd's procedure. All children in group B and 15 in group A had an uneventful recovery and tolerated oral feedings within the first 10 days postoperatively without any complication. Six children in group A had prolonged postoperative ileus and were treated with total parenteral nutrition (TPN), gastric decompression, and radiologic evaluation of anastomotic patency. These 6 children eventually tolerated oral feeding between the 18th and 45th postoperative days. In 1 child a technical error was found that caused a prolonged ileus. Three children died within the 1st postoperative week. It is concluded that simple establishment of continuity of the gastrointestinal tract by performing the appropriate surgical procedure in combination with TPN and gastric decompression gives satisfactory results in the management of duodenal obstruction.Presented at the 15th Annual International Meeting arranged by the Greek Association of Pediatric Surgeons.