Duodenal obstruction in neonates: Management and outcome

Objective: to find out the clinical presentation,type of duodenal obstruction,management and outcome of neonates presenting with duodenal obstruction. study design: case series. place and duration of study: department of pediatric & neonatal surgery,b.v. hospital bahawalpur from march 2011 to march 2013. methodology: all the neonates presenting with acute duodenal obstruction were included in the study. diagnosis was made on clinical presentation of bilious vomiting and classical double bubble sign on x ray abdomen. 7 out of 27 neonates were having prenatal suspicion of duodenal obstruction. all neonates were evaluated for associated other congenital abnormalities. standard diamond shaped duodenodudenostomy was performed in all cases except in 2 cases where malrotation was the primary cause of duodenal obstruction and it was corrected. all cases were managed in the ward and were followed in opd for long term outcome. results: there were a total of 27 neonates with mean gestational age was 38.87 weeks ± 1.2094 sd. mean weight was 2.767 kg ± 0.5299kg sd. sixteen (16) of them were male and eleven (11) were female.18 cases (66.66%) had complete duodenal atresia while 3 (11.11%) had duodenal web,3 (11.11%) had annular pancrease,2 (7.40%) had extrinsic duodenal obstruction due to malrotation and 1 (3.70%) had preduodenal portal vein. 5 cases (18.51%) were found to had associated down syndrome and 4 cases (14.81%) were having associated cardiac defect. in 25 cases standard diamond shaped duodenodudenostomy was performed. in 2 cases correction of malrotation with ladd's procedure was performed which relieved extrinsic pressure over duodenum. post operatively in 2 cases there was anastomosis leakage and re-operation was performed. mean hospital stay was 8.63 days ± 1.944 sd. in eleven cases partial parentral nutrition was given for 7 days. all patients were followed up after discharge for 2 weeks. then every 3 months up to 1 year. 2 cases presented with surgical wound infection with granulation tissue at operation site which was curetted and re stitched. in 11 cases gastro-esophageal reflux was observed which was managed conservative,3 cases developed adhesive intestinal obstruction which was also managed conservative. conclusion: duodenal obstruction must be kept in mind in neonates presenting with bilious vomiting. the association of down syndrome and cardiac defects and other genetic disorders with duodenal obstruction necessities the need of prenatal diagnosis so that these neonates may be delivered in tertiary care hospital and managed in time for better outcome of the disease. further duodenodudenostomy is the best surgical answer for most of the cases of duodenal obstruction. © 2015,pakistan pediatric journal. all rights reserved.