DUODENAL OBSTRUCTION IN CHILDREN: AN EIGHT YEAR EXPERIENCE IN BASRAH
Abbas Abdulzahra Alhasani
MB, ChB, FIBMS, MRCS Glasgow, Pediatric Surgeon, Lecturer, Department of Surgery, College of Medicine, University of Basrah, IRAQ.
Duodenum is a common site for congenital anomalies that might result in partial or complete obstruction. Intestinal rotational anomalies that involve the midgut put the duodenum at a potential risk of obstruction.
This is a retrospective hospital record based study displaying an 8 year single center experience in the Basrah center of pediatric surgery. The study enrolled 60 children with congenital duodenal obstruction with a mean age of 2.8 months and a male to female ratio of 1.14:1. Thirty two patients (53.3%) were diagnosed as duodenal atresia and stenosis, while intestinal malrotation was reported in 28 patients (46.7%). Repeated vomiting was the most common presenting symptom, it was bile stained in 60%. Associated congenital anomalies were seen in 23.3% of the study population, Down's syndrome and congenital heart defects were the most commonly reported abnormalities.
Intraoperatively, fenestrated duodenal web was the commonest finding (59.4%) in duodenal atresia/stenosis, which was corrected by a diamond anastomosis in 1.9% of cases and by duodenotomy with web excision in 28.1%. Malrotation was corrected by Ladd's operation in 92.9%. Postoperative complications were reported in one third of the studied population, and the type of surgical procedure used in duodenal atresia/stenosis did not have a significant impact neither on postoperative complications nor on the hospital stay.