Duodenal motility after tapering duodenoplasty for high jejunal and multiple intestinal atresia

Duodenal motility after tapering duodenoplasty was investogated by radiography and video-fluoroscopy. Two patients underwent tapering duodenoplasty, one at the time of duodenojejunostomy for double high jejunal atresias and another 6.5 months after the restoration of intestinal continuity for multiple intestinal atresias. Both patients showed a satisfactory postoperative course and were doing well. Radiographic and video-fluoroscopic studies demonstrated that the tapered portion of the duodenum had restored active peristalsis and excellent passage of contrast material, while the proximal, non-tapered portion remained dilated and dismotile soon after the operation. Tapering duodenoplasty proved to be a valuable procedure for restoring duodenal motility. Correspondence to: M. Honzumi     

Excision duodenoplasty: a new technique for congenital duodenal obstruction

Slow anastomotic function is a common problem in the management of congenital duodenal obstruction. We describe a simple technique of excision duodenoplasty (ED) that results in a fixed open anastomosis, which facilitates early commencement of feeds and discharge from hospital. A retrospective case-note review (1981–2000) was undertaken to compare the results of ED with side-to-side duodenoplasty (SSD) and diamond-shaped anastomosis (DD). The outcome measures were days to commencement of feeds, duration of total parenteral nutrition (TPN), and length of hospital stay. In ED a 1.0 to 1.5-cm elleptical segment of dilated duodenum is excised. A longitudinal incision is made in the smaller distal duodenum. A side-to-side one-layer anastomosis is performed. The wall of the proximal duodenal stump is thick, and excision of the ellipse keeps the anastomosis open by preventing apposition of the opposing walls. This facilitates good drainage across the anastomosis. The time to onset of feeding was longer after SSD (median 7 days) compared to ED (5 days) and DD (5 days). The total duration of TPN was also longer for SSD (9 days) in comparison to ED (7 days) and DD (7 days). Although the duration of hospital stay was more for SSD (18 days) than ED (13 days) and DD (16 days), this difference was not statistically significant. The ED technique thus gives an equally good result as DD and a better result than SSD. It is simple to perform and to teach. Accepted: 26 February 2001     

Congenital intrinsic duodenal obstruction: a comparative review of associated anomalies

A review of 68 cases of intrinsic duodenal obstruction from The Adelaide Children's Hospital is presented, with Particular reference to the differing Incidence of associated anomalies.
In this series there is a high incidence of other anomalies associated with atresia and stenosis when compared with a low incidence associated with membrane obstruction — particularly Down's syndrome and congenital heart disease. The overall survival with surgery is 67%.     

Reconstruction for duodenal atresia: tapered or non-tapered duodenoplasty?

The short-term outcome of surgery for congenital duodenal stenosis or atresia has been evaluated by studying the case-notes of 37 patients treated between 1988 and 1993. Eighteen underwent tapered duodeno-duodenostomy; biliary complications occurred in 3 and 1 developed an adhesive intestinal obstruction. Transient post-operative vomiting occurred in 1 other patient. Nineteen patients underwent non-tapered duodeno-duodenostomy. One die 19 days post-operatively; 1 developed an intra-peritoneal abscess and another an adhesive intestinal obstruction. Transient post-operative vomiting occurred in 3 other patients. Full intra-gastric feeding was achieved between a mean of 13 and 14 days in both groups. There was no advantage to either technique with regard to the time of establishment of full intra-gastric feeding. Although there were surgical complications in both groups, it appears that tapered duodenoplasty carries a considerable risk of incidental biliary injury.     

腹腔镜与开腹手术治疗先天性十二指肠梗阻疗效比较的Meta分析

目的:通过Meta分析系统比较腹腔镜手术(laparoscopic surgery,LS)与传统开腹手术(open surgery,OS)治疗先天性十二指肠梗阻的临床疗效。方法:检索万方数据库、中国知网、维普数据库、PubMed、Web of Science数据库、Cochrane图书馆,收集近10年国内外LS与OS治...     

Congenital duodenal obstruction with Down's syndrome and Hirschsprung's disease

Two rare cases of congenital duodenal obstruction (CDO) with Down's syndrome and Hirschsprung's disease (HD) are reported. The incidence of associated anomalies in CDO, with reference to the literature, and the diagnosis of HD with CDO are discussed. If intestinal dilation or difficulty in defecation persist after CDO has been diagnosed and relieved, then a barium enema should be repeated together with anorectal manometric and rectal mucosal histologic studies in consideration of HD.     

Gastric outlet obstruction caused by prepyloric mucosal diaphragm mimicking duodenal ulcer: a case report

An 11-year-old child was evaluated for chronic gastric obstruction with intermittent symptoms from the age of 11 months. An upper gastrointestinal series performed at the age of 11 months was interpreted as compatible with severe pyloric stenosis due to a duodenal ulcer, but no surgery was recommended. Several other UGIT series, and at least four endoscopies performed during the following years by experienced gastroenterologists in Israel and in the United States, failed to reveal the true nature of the gastric outlet obstruction. The patient was operated upon shortly after referral to our institute. Upon celiotomy, a congenital antral web was found, the excision of which resulted in long-term relief of all symptoms. The differential diagnoses of childhood gastric outlet obstruction and the possible pitfalls in the diagnostic workup are discussed.     

新生儿十二指肠梗阻诊断与治疗探讨

为探讨新生儿十二指肠梗阻的诊断与治疗方法，回顾性分析了57例年龄1天至3个月的十二指肠梗阻病例临床表现和手术治疗疗效。57例中早产儿和未成熟儿占14．0％；病种包括先天性肠旋转不良40例次，十二指肠闭锁狭窄16例次，环状胰腺6例次，肠系膜上动脉综合征1例次，其中6例（11．5％）有2种原因的梗阻、手术方式按病理改变而定，包括肠旋转不良Ladd手术40例次，隔膜切除、十指肠成形12例次，十二指肠十二指肠菱形吻合2例次，十二指肠空肠侧侧吻合9例次。有6例术中将鼻胃管插入至空肠作为“经吻合口的十二指肠支架管”，并加作腹壁筋层减张缝合。术后主要并发症有腹壁切口裂开6例，十二指肠梗阻4例（吻合狭窄3例，漏诊隔膜1例），肺炎3例。“经吻合口的十二指肠支架管”加腹壁筋膜层减张缝合术6例术后无并发症。全组死亡4例，病死率7．0％（4／57例）。提示新生儿十二指肠梗阻的主要病因是先天性肠旋转不良，十二指肠闭锁狭窄和环状胰腺，部分病例有2种原因，主要手术并发症是腹壁切口裂开和吻合口狭窄。“经吻合口的十二指肠支架管”可避免隔膜被遗漏和吻合口狭窄，腹壁筋膜层减张缝合可避免切口裂开。     

Congenital duodenal obstruction due to a preduodenal portal vein

Only about 80 cases of pre-duodenal protal vein (PDPV), a rare congenital anomaly of portal vein development that was first described by Knight in 1921, have been reported till date. We report a neonate with duodenal obstruction caused by PDPV and briefly review the available literature.     

The posterior urethral valve uropathy: Results of treatment

Nineteen children treated for posterior urethral obstruction due to congenital valve in the University of Benin Teaching Hospital, Benin City, Nigeria, over a 9-year period have been analysed. Their ages ranged from birth to 12 years. Results show that associated kidney pathology may be irreversible even after successful excision of the valve. This determines the final prognosis, which is worse the younger the child at presentation.     

腹腔镜治疗新生儿先天性十二指肠梗阻围术期管理

目的探讨腹腔镜治疗新生儿先天性十二指肠梗阻(CDO)的围术期管理方法。方法回顾性分析2002年7月-2011年4月28例CDO患儿腹腔镜手术的临床资料。男18例,女10例。肠旋转不良18例,十二指肠隔膜型狭窄6例,十二指肠闭锁、环状胰腺各2例。分别于术前、术中和术后针对不同患儿采取个体性规范化的管理措施,保证患儿的顺利治疗和恢复。结果 28例CDO患儿均顺利完成手术。其中Ladd手术18例,前壁纵行切开隔膜切除后横行缝合术6例,十二指肠菱形吻合术4例。28例均顺利出院,住院时间7～13 d。术后肠梗阻2例,新生儿寒冷损伤综合征1例,经治疗后均痊愈。随访2～68个月[(31.3±4.8)个月],生长发育均正常。结论新生儿CDO经腹腔镜手术治疗是一种安全有效的方法,但需要有针对性地进行个体化的围术期管理,才能保证手术的安全实施。     

Innominate artery enlargement in congenital arteriovenous fistula with subsequent tracheal compression and stridor

To demonstrate that airway obstruction may be the first manifestation of a congenital fistula, a female newborn is reported who presented with increasing stridor during her first 23 months of life. Magnetic resonance imaging and Doppler echocardiography revealed an enlarged innominate artery with turbulent flow. Angiography demonstrated an arteriovenous fistula between the right subclavian artery and right subclavian vein and an abnormal origin of the right internal thoracic artery. Bronchoscopy showed a pulsating compression of the middle section of the trachea. Closure and division of the fistula and aortotruncopexy were performed. The stridor disappeared, and there was marked relief of the tracheal obstruction, confirmed by bronchoscopy. It is concluded that, a search for enlarged vessels is necessary in cases of airway obstruction.     

新生儿十二指肠梗阻64例

目的探讨新生儿先天性十二指肠梗阻的诊断、病理类型及治疗方法。方法对64例新生儿十二指肠梗阻患儿的术前诊断、病理类型、治疗方法及预后进行回顾性分析。其中18例行产前B超筛查。64例均经手术探查,59例术前行上消化道造影。肠旋转不良34例(合并肠坏死6例),33例行Ladd手术,4例加做肠切除、肠吻合术;十二指肠闭锁与狭窄12例,7例行隔膜切除及肠壁纵切横缝术,2例行十二指肠端端吻合术;其余3例及环状胰腺5例行十二指肠前壁菱形侧侧吻合术;2种原因梗阻者13例,其中十二指肠闭锁并肠旋转不良6例,十二指肠闭锁并环状胰腺1例,十二指肠闭锁并多发隔膜3例,环状胰腺并肠旋转不良2例,肠旋转不良并幽门隔膜1例,根据患者情况行单一或联合术式。结果行产前B超筛查患儿中12例(12/18,66.7%)怀疑十二指肠梗阻。上消化道造影的临床符合率为98.3%。64例患儿中58例痊愈(治愈率为90.6%),4例医院内死亡,2例放弃治疗。术后并发症主要包括黏连性肠梗阻5例,肠扭转、吻合口狭窄、漏诊多发畸形各1例,其中需要二次手术4例。结论产前B超有助于胎儿高位肠梗阻的早期发现;上消化道造影和B超是诊断十二指肠梗阻的有效方法;早期诊断、合理选择手术方式、避免漏诊及加强围手术期处理是提高治愈率的关键;发生肠扭转并长段肠坏死者预后不佳。     

Duodenoplasty in the management of duodenal atresia

When the duodenum is congenitally obstructed it becomes distended to varying degrees. Our case of combined duodenal and multiple jejunal atresias indicates the value of duodenoplasty for symptomatic duodenomegaly diagnosed in late childhood. The technique used has restored duodenal motility and is recommended for selective use as part of the primary surgery for duodenal and proximal jejunal atresia. Offprint requests to: E. J. Guiney     

MR imaging appearance of laryngeal atresia (congenital high airway obstruction syndrome): unique course in a fetus

Congenital high airway obstruction syndrome (CHAOS) is a rare life-threatening syndrome. Most cases are diagnosed prenatally by US. We report a fetus with this syndrome that showed a unique course revealed on MRI. Ultrasonography at 22 weeks demonstrated that the fetus had ascites and bilaterally enlarged hyperechoic lungs. Congenital infection, congenital cystic adenomatoid malformation or CHAOS was suspected. Subsequent MRI performed at 24 weeks demonstrated bilaterally enlarged high-signal lungs, dilated bronchi, massive ascites, subcutaneous oedema and polyhydramnios. MRI confirmed the diagnosis of CHAOS. A second MRI at 35 weeks showed that the bilateral lung enlargement, ascites, oedema and polyhydramnios had resolved, but that the appearance of the airway was unchanged. The infant was delivered by caesarean section at 38 weeks of gestation and immediate tracheostomy was performed. This spontaneous regression was explained by a tracheo-oesophageal fistula that may have decreased the intrathoracic pressure.     

Congenital mesenteric hernia causing intestinal obstruction in children

A mesenteric hernia is one type of intraperitoneal hernia. There is no hernia sac in this situation but only a mesenteric defect, which is present at birth. Strangulated mesenteric hernia is a rare cause of intestinal obstruction especially in the pediatric population. Between January 1996 and January 2006, four patients with intestinal obstruction were determined to have congenital mesenteric hernia at Chang Gung Children’s Hospital. Patients consisted of three boys and one girl, ranging in age from 2 years 5 months to 5 years 4 months. All patients presented with symptoms and signs indicative of intestinal obstruction. On physical examination, all patients appeared to be severely ill. A shock-like state was associated with necrosis of the strangulated bowel in two patients. A palpable abdominal mass was present in one patient with volvulus of small bowel. The plain abdominal radiography and the ultrasound scan also showed dilatation of the small bowel and excluded intussusception. All the patients underwent laparotomy after initial resuscitation. During laparotomy, three patients had incarceration of small bowel through the small mesenteric defect, and another one had volvulus with gangrenous bowel entrapped within a large mesenteric defect. The defects ranged in size are from 2 to 7 centimeters in diameter. Simple reduction of the incarcerated bowel with repair of the defect was performed in two patients, resection of gangrenous bowel and primary anastomosis was required in one patient, and resection with end ileostomy was needed in another one patient. There was no postoperative mortality in our patients. Conclusion: A mesenteric hernia is a rare cause of intestinal obstruction, especially in children. Open exploration is the only way to establish a clear anatomic diagnosis.     

Intracardiac causes of superior vena cava obstruction

Most causes of superior vena cava (SVC) obstruction are extracardiac. In rare instances, an intracardiac process may obstruct the venous return from the SVC. This is illustrated by a report of a patient with a congenital coronary artery fistula to the right atrium obstructing the SVC return. We propose a classification and clinical approach to the differential diagnosis of SVC obstruction.Abbreviation SVC superior vena cava     

Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis

Intestinal obstruction and bleeding are uncommon complications of congenital syphilis (CS). A VDRL-positive infant developed incomplete intestinal obstruction and rectal bleeding. Despite conservative management, his symptoms continued. At laparotomy, terminal ileal inflammation and stenosis were demonstrated. He underwent ileal resection and primary end-to-end anastomosis with resolution of his symptoms. Histopathological examination demonstrated heavy plasmacytic infiltration of the lamina propria and submucosa with ulceration of the mucosa, consistent with syphilitic ileitis. This report documents for the first time bleeding from ileal ulcers associated with intestinal obstruction in CS and highlights an unusual presentation of the disease. Accepted: 30 June 1998     

MRU在小儿泌尿系梗阻的诊断意义

目的 比较泌尿系梗阻的各种影像学诊断方法，讨论磁共振尿路造影(MRU)对泌尿系梗阻的诊断意义。方法 分析23例患儿术前行MRU检查的资料，与B超、静脉尿路造影(IVU)、逆行尿路造影、CTU等影像学诊断资料进行对比。结果 23例B超检查15例显示明确，静脉尿路造影有7例不显影或显影不清，CTU检查12例，其中8例显影，4例显影不清楚。MRU检查23例，均显影清楚。结论 MRU能显示无功能性肾脏集合系统，还有无需碘造影剂的优点，在儿童泌尿系梗阻辅助检查中有着重要作用。