Although survival rates for infants undergoing surgical treatment for congenital intrinsic
duodenal obstruction are high, long-term follow-up suggests a high complication rate related to surgical
therapy. We reviewed 33 neonates who underwent surgery for congenital intrinsic
duodenal obstruction during the past 10 years. There were 20 girls and 13 boys; the mean gestational age was 36 weeks, and mean
birthweight was 2,485 g. Bilious
vomiting and
intestinal obstruction were the most frequent presenting symptoms.
Hydramnios was present in 75% of cases and 21% had associated
Down's syndrome. Findings at
laparotomy included
duodenal atresia (14), annular pancreas (11), and duodenal diaphragm (8). The most frequent
surgical procedure was side-to-side duodenoduodenostomy (DD), followed by duodenojejunostomy and resection of web with Heineke-Mikulicz type duodenoplasty. Bowel transit was reestablished at a mean of 13.1 days (range, 6 to 45 days). Seventy-percent of patients developed postoperative complications, the most frequent being megaduodenum with
blind loop syndrome or
bile reflux gastritis (22%),
cholestatic jaundice (17%),
gastroesophageal reflux (17%), delayed transit (8%), and bowel obstruction (8%). Six patients (18%) required secondary
surgical procedures for postoperative complications (ie, megaduodenum, nonfunctioning anastomosis, missed intrinsic
stenosis). Two patients died (6%). Stagnation and functional obstruction in the proximal duodenum is the main factor influencing the morbidity rate among these patients. Consideration should be given to the tapering duodenoplasty and
diamond-shaped anastomosis in order to help reduce problems associated with megaduodenum and help restore earlier bowel transit.