Congenital intrinsic duodenal obstruction: Clinical study and predictors of neonatal surgical mortality
DOI:
https://doi.org/10.52783/jns.v11.1034Keywords:
Congenital duodenal obstruction, Duodenal atresia, Duodenal web, Duodenoduodenostomy, Neonatal surgical mortalityAbstract
Background: This study was aimed to analyze the clinical profile and the predictors of neonatal surgical mortality of congenital intrinsic duodenal obstruction (CIDO).
Methods: This is a case series of 67 patients with CIDO (duodenal atresia and stenosis) admitted at our teaching institute, from October 2018 to June 2020. The demographic data, clinical presentation, diagnostic methods, location & type of duodenal atresia, the operative procedure performed, and neonatal surgical mortality (NSM) predictors such as birth weight, age on presentation, associated anomalies, duration of surgery, extubation after surgery, sepsis, and vasopressors support were analyzed.
Results: Of 67 patients, 40(60%) were premature; mean weight and age at presentation were 2.06±0.6 (1-8 kg) and 6.7(1-240days), respectively. The majority of patients (59, 88%) presented with vomiting, and the most common finding on the x-ray abdomen was a double bubble sign (54, 81%). Twenty-four (36%) were associated with congenital heart disease and 19(28%) had Down’s syndrome. Type 3 duodenal atresia was the commonest finding in 43(64%) followed by type 1 in 22 (33%), and type 2 in 2(3%). In 49 (73%) Kimura’s duodenoduodenostomy, excision of web & duodenoplasty in 13 (19%), and side to side duodenoduodenostomy in 4 (6%), were performed. The mean hospital stay of survivors was 9 days. Overall survival was 63%.
Conclusion: Type 3 duodenal atresia is the commonest variety observed. The prematurity, low birth weight, associated major congenital anomalies, surgery >90 minutes, delayed extubation after surgery, sepsis, and need for vasopressors support are significant predictors of NSM.
Downloads
Metrics
References
Al-Salem AH. Congenital intrinsic duodenal obstruction: a review of 35 cases. Ann Saudi Med. 2007; 27:289-92.
Applebaum H, Sydorak R. Duodenal atresia and stenosis- annular pancreas. In: Coron AG, editor. Pediatric surgery, 7th ed. Philadelphia: Elsevier; 2012. p. 1051-7.
Dalla Vecchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer LR, Engum SA. Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg. 1998; 133:490-7.
Mustafawi AR, Hassan ME. Congenital duodenal obstruction in children: a decade's experience. Eur J Pediatr Surg. 2008; 18:93-7.
Choudhry MS, Rahman N, Boyd P, Lakhoo K. Duodenal atresia: associated anomalies, prenatal diagnosis and outcome. Pediatr Surg Int. 2009; 25:727-30.
Ogle SB, Nichol PF, Ostlie DJ. Duodenal and intestinal atresia and stenosis. In: Holcomb III GW, editor. Holcomb and Ashcraft's Pediatric Surgery, 7th ed. China: Elsevier; 2020. P. 489-506.
Hancock BJ, Wiseman NE. Congenital duodenal obstruction: The impact of an antenatal diagnosis. J Pediatr Surg. 1989; 24:1027–31.
Bailey PV, Tracy TF, Connors TR, Monney DP, Lewis JE, Weber TR: Congenital duodenal obstruction: A 32-year review. J Pediatr Surg. 1993; 28:92-5.
Akhtar J, Guiney EJ. Congenital duodenal obstruction. Br J Surg. 1992; 79:133-5.
Moutquin JM. Classification and heterogeneity of preterm birth. BJOG. 2003; 110:30-3.
Cutland CL, Lackritz EM, Mallett-Moore T, Bardají A, Chandrasekaran R, Lahariya C, et al. Brighton Collaboration Low Birth Weight Working Group. Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine. 2017; 35:6492-500.
Pawar N, Singh AP, Gupta AK, Tanger R. VACTERL association with left pulmonary agenesis in an infant. Formos J Surg. 2019; 52:232-4.
Partridge E, Hedrick HL. Duodenal atresia and stenosis. In: Losty PD, editor. Rickham’s Neonatal Surgery, 1st ed. London: Springer; 2018. P. 675-81.
Al-Salem AH. Congenital duodenal obstruction. In: Al-Salem AH. editor. Atlas of Pediatric Surgery – Principles and treatment, 1st ed. Cham: Springer; 2020. P. 433-44.
Bales C, Liacouras CA. Intestinal atresia, stenosis, and malrotation. In Kliegman RM editor. Nelson's Textbook of Pediatrics, 20th ed. Philadelphia: WB Saunders, 2016. P. 1800-1.
Girvan DP, Stephens CA. Congenital intrinsic duodenal obstruction: a twenty-year review of its surgical management and consequences. J Pediatr Surg. 1974; 9:833-9.
Al-Salem AH, Khwaja S, Grant C, Dawodu A. Congenital intrinsic duodenal obstruction: problems in the diagnosis and management. J Pediatr Surg. 1989; 24:1247-9.
Gupta S, Gupta R, Ghosh S, Gupta AK, Shukla A, Chaturvedi V, et al. Intestinal atresia: Experience at a busy center of North-West India. J Neonatal Surg. 2016; 5:51.
Garg D, Barolia DK, Singh AP, Mathur V. Neonatal intestinal obstruction – our institutional experience. Int J Med Sci Innov Res. 2019; 4:144-50.
Bethell GS, Long AM, Knight M, Hall NJ; BAPS-CASS. Congenital duodenal obstruction in the UK: a population-based study. Arch Dis Child Fetal Neonatal Ed. 2020; 105:178-83.
Puri A, Lal B, Nangia S. A pilot study on neonatal surgical mortality: A multivariable analysis of predictors of mortality in a resource-limited setting. J Indian Assoc Pediatr Surg. 2019; 24:36-44.
Catre D, Lopes MF, Madrigal A, Oliveiros B, Viana JS, Cabrita AS, et al. Early mortality after neonatal surgery: Analysis of risk factors in an optimized health care system for the surgical newborn. Rev Bras Epidemiol. 2013; 16:943–52.
Ilori IU, Ituen AM, Eyo CS. Factors associated with mortality in neonatal surgical emergencies in a developing tertiary hospital in Nigeria. Open J Pediatr. 2013; 3:231–5.
Manchanda V, Sarin YK, Ramji S. Prognostic factors determining mortality in surgical neonates. J Neonatal Surg. 2012; 1:3.
Anand KJ, Aynsley-Green A. Measuring the severity of surgical stress in newborn infants. J Pediatr Surg. 1988; 23:297–305.
Snaidauf J, Kalousova J, Styblova J, Fryc R, Pycha K, Petru O, et al. Results of treatment of esophageal atresia. Cas Lek Cesk. 2004; 143:614-7.
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Dr. Prmila Sharma, Dr. Naresh Pawar, Dr. Arun Kumar Gupta
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
