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Song A, Xiang X, Zhang B, Li X, Guo Z. Single-incision Laparoscopic Surgery for Neonatal Congenital Duodenal Obstruction: A Retrospective Study of 130 Patients. J Pediatr Surg 2025; 60:162113. [PMID: 39765028 DOI: 10.1016/j.jpedsurg.2024.162113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 11/28/2024] [Accepted: 12/14/2024] [Indexed: 02/26/2025]
Abstract
OBJECTIVES This study sought to assess the advantages of utilizing the single-incision laparoscopic surgery (SILS) procedure for repairing neonatal congenital duodenal obstruction (CDO) in terms of clinical outcomes and complication rates. METHODS In a retrospective cohort study conducted at a single center, neonates with CDO who underwent SILS were compared to those who underwent conventional laparoscopic surgery (CLS) between January 2018 and December 2022. The demographic and operative characteristics of CDO patients who underwent SILS or CLS were analyzed, including conversion rates and postoperative complications. RESULTS Of these, 75 patients were assigned to the CLS group, while 55 patients belonged to the SILS group. No statistically significant differences were detected between the two groups in terms of baseline characteristics. The median operative time was significantly longer in the SILS group than in the CLS group (130 min vs. 120 min, P = 0.02). The SILS group experienced a longer delay in the initiation of feeds than did the CLS group (5 days vs. 4 days, p = 0.001); however, there was no statistically significant difference in the time to reach full feeds between the two groups (9 days vs. 9 days, p = 0.07). In the SILS group, the incidences of incisional hernia and infection were higher than those in the CLS group, but the differences were not statistically significant (9.09 % vs. 4.00 %, P = 0.41 & 10.91 % vs. 5.33 %, P = 0.39). There were no statistically significant differences in the incidences of anastomotic stricture/leakage, adhesive intestinal obstruction, or missed diagnosis related to malformation between the two groups. The incidence of conversion to laparotomy was found to be 6.67 % and 9.09 % in the respective groups, with no statistically significant difference detected. CONCLUSION The efficacy and safety of the SILS procedure for neonatal CDO repair are comparable to those of the CLA procedure, and the SILS procedure has potential cosmetic advantages.
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Affiliation(s)
- Aohua Song
- Department of Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, PR China
| | - Xiao Xiang
- Department of Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, PR China
| | - Bobin Zhang
- Department of Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, PR China
| | - Xunfeng Li
- Department of Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, PR China
| | - Zhenhua Guo
- Department of Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, PR China.
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Cazares J, Colín-Garnica J, Cantú-Reyes JA, Sepulveda-Valenzuela M, Torres-Salas M, de la Rosa-Bustamante E, Guillen-Cárdenas A. Minimally Invasive Surgery for Duodenal Obstructions: 10 Years of Experience in a Single Center. J Pediatr Surg 2024; 59:161700. [PMID: 39304485 DOI: 10.1016/j.jpedsurg.2024.161700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE Duodenal obstructions are one of the most common causes of upper intestinal obstruction during the neonatal period. Minimally invasive surgical treatment is considered highly complex. We report our experience with 43 patients treated using this method. METHODS We conducted a retrospective study at our institution from January 2013 to May 2023, including patients classified as having upper intestinal obstructions. All patients received preoperative diagnoses based on clinical findings, radiography, and abdominal ultrasound. Laparoscopic surgery was performed on all patients. RESULTS We included 43 patients diagnosed with duodenal obstruction (DO) in our study after reviewing the medical records at our hospital for cases meeting this diagnosis. The laparoscopic Kimura procedure was performed on 31 patients (72%), while duodenotomy and anastomosis following the Heineke-Mikulicz principle were performed on 9 patients (21%). In the remaining 3 patients (7%), a side-to-side duodeno-duodeno anastomosis was conducted. Annular pancreas was the most common cause of duodenal obstruction in our series, affecting 21 patients (49%). Type I duodenal atresia was observed in 17 patients (40%), while type III atresia was present in 3 patients (7%), and type II atresia in 2 patients (4%). One case required conversion to open surgery due to concomitant jejunoileal atresia. The only reported complication was partial anastomotic dehiscence, which occurred in two patients (4%). CONCLUSIONS Minimally invasive surgery (MIS) for managing duodenal obstruction (DO) has proven to be both feasible and safe, yielding comparable outcomes to the traditional open approach; its effectiveness can be significantly enhanced through appropriate training. Furthermore, the growing availability of duodenal atresia simulators offers valuable opportunities to refine laparoscopic skills and apply them effectively. Better outcomes and fewer complications are expected with further experience and an increased number of cases. LEVEL OF EVIDENCE IV, Case series with no comparison group.
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Affiliation(s)
- Joel Cazares
- Department of Pediatric Surgery, Hospital Regional de Alta Especialidad Materno Infantil, Monterrey, Mexico.
| | - Jorge Colín-Garnica
- Pediatric Surgery Residency Program Universidad de Monterrey (UDEM), Hospital Regional Materno Infantil de Alta Especialidad de Nuevo Leon, Monterrey, Mexico
| | - Jorge Alberto Cantú-Reyes
- Department of Pediatric Surgery, Hospital Regional de Alta Especialidad Materno Infantil, Monterrey, Mexico
| | | | - Miguel Torres-Salas
- Department of Pediatric Surgery, Hospital Regional de Alta Especialidad Materno Infantil, Monterrey, Mexico
| | - Eduardo de la Rosa-Bustamante
- Pediatric Surgery Residency Program Universidad de Monterrey (UDEM), Hospital Regional Materno Infantil de Alta Especialidad de Nuevo Leon, Monterrey, Mexico
| | - Arturo Guillen-Cárdenas
- Pediatric Surgery Residency Program Universidad de Monterrey (UDEM), Hospital Regional Materno Infantil de Alta Especialidad de Nuevo Leon, Monterrey, Mexico
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Plutecki D, Ostrowski P, Bonczar M, Michalik W, Konarska-Włosińska M, Goncerz G, Juszczak A, Ghosh SK, Balawender K, Walocha J, Koziej M. Exploring the clinical characteristics and prevalence of the annular pancreas: a meta-analysis. HPB (Oxford) 2024; 26:486-502. [PMID: 38310080 DOI: 10.1016/j.hpb.2024.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/17/2023] [Accepted: 01/15/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The annular pancreas (AP) is a rare gastrointestinal congenital malformation, in which malrotation of the pancreatic ventral bud in the seventh week of embryonic development manifests in a partial or complete ring of tissue around the second part of the duodenum. METHODS The main online medical databases such as PubMed, ScienceDirect, Wiley online library, Web of Science, and EBSCO discovery service were used to gather all relevant studies on the AP. RESULTS A total of 12,729,118 patients were analyzed in relation to the prevalence of AP. The pooled prevalence of AP was 0.0045% (95% CI: 0.0021%-0.0077%). The most frequent comorbidity in adults and children was duodenal obstruction, with a pooled prevalence of 24.04% and 52.58%, respectively (95% CI: 6.86%-46.48% and 35.56%-69.31%, respectively). The most frequent operation in adult patients with AP was duodenojejunostomy, with pooled prevalence established at 3.62% (95% CI: 0.00%-10.74%). CONCLUSION The diagnostic complexity of AP is accentuated by its nonspecific clinical symptoms, making accurate identification reliant on imaging studies. Therefore, having a thorough knowledge of the clinical characteristics of the AP and its associated anomalies becomes paramount when faced with this rare congenital condition.
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Affiliation(s)
- Dawid Plutecki
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland; Youthoria, Youth Research Organization, Kraków, Poland
| | - Patryk Ostrowski
- Youthoria, Youth Research Organization, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Bonczar
- Youthoria, Youth Research Organization, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Weronika Michalik
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Grzegorz Goncerz
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksiej Juszczak
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Department of General Surgery, 5th Military Hospital, Kraków, Poland
| | - Sanjib K Ghosh
- Department of Anatomy, All India Institute of Medical Sciences, 3rd Floor, Academic Building, Phulwarisharif, Patna, Bihar 801507, India
| | - Krzysztof Balawender
- Department of Normal and Clinical Anatomy, Institute of Medical Sciences, Medical College, Rzeszow University, 35-315 Rzeszów, Poland
| | - Jerzy Walocha
- Youthoria, Youth Research Organization, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Koziej
- Youthoria, Youth Research Organization, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.
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Mack SJ, Pace DJ, Patil S, Cooke-Barber J, Berman L, Boelig MM. Association of Age at Duodenal Atresia Repair With Outcomes: A Pediatric NSQIP Analysis. J Pediatr Surg 2024; 59:18-25. [PMID: 37833211 DOI: 10.1016/j.jpedsurg.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/06/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE Neonates with duodenal atresia (DA) are often born prematurely and undergo repair soon after birth, while others are delayed to allow for growth until closer to term corrected gestational age (cGA). Premature infants have been demonstrated to experience worse outcomes, but it is unclear whether delaying surgery mitigates the increased morbidity. This study evaluates the association of timing of DA repair with postoperative morbidity. METHODS We retrospectively evaluated neonates undergoing DA repair from the National Surgical Quality Improvement Program-Pediatric database (2015-2020). A multivariable regression analyzed factors associated with composite morbidity, including cGA and age in days of life (DOL) at surgery. A propensity score matched analysis was completed in premature neonates born at ≤35 weeks gestation to compare outcomes at similar birth gestational ages (bGA) and birth weight who underwent early (<7 DOL) versus delayed (≥7 DOL) repair. RESULTS 809 neonates were included with a median bGA of 36 weeks (IQR 34-38), birth weight of 2.46 kg (IQR 1.96-2.95), and DOL at surgery of 2 (IQR 1-5). Infants born ≤35 weeks represented 35.23% of the cohort. On multivariable analysis, increasing cGA at surgery was associated with decreased morbidity (OR: 0.91, CI [0.84, 0.99]), and increasing DOL at surgery was associated with increased morbidity (OR: 1.02, CI [1.00, 1.04]). On propensity score matched analysis, delayed repairs were associated with increased postoperative ventilation (6 days vs. 2 days, p < 0.05); however, there were no differences in composite or surgical morbidity between early and delayed repairs. CONCLUSIONS Morbidity after DA repair in neonates ≤35 weeks cGA is primarily driven by non-surgical causes, but delaying surgery does not appear to mitigate the risks associated with prematurity. It seems reasonable to consider repair in neonates around 33-34 weeks gestation without prohibitive risk factors. Optimal timing of DA repair requires a delicate balance between these factors. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Retrospective Cohort Study.
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Affiliation(s)
- Shale J Mack
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Devon J Pace
- Thomas Jefferson University Hospital, Philadelphia, PA, USA; Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Sanath Patil
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Jo Cooke-Barber
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Matthew M Boelig
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
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Liu J, Chen Y, Wang H, Huang D, Du Y, Liu X, Sun X, Yan C, Chen W, Wang H, Zhang R. Novel qualitative and quantitative ultrasound markers to facilitate prenatal diagnosis of congenital duodenal obstruction. J Matern Fetal Neonatal Med 2023; 36:2167072. [PMID: 36726301 DOI: 10.1080/14767058.2023.2167072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Accurate prenatal diagnosis of congenital duodenal obstruction (CDO) is challenging. We aimed to determine new ultrasound metrics for accurate prenatal diagnosis of fetal CDO. METHODS Data pertaining to 46 fetuses with suspected small intestinal obstruction (26 CDO; 16 high jejunal obstructions) were retrospectively analyzed. Prenatal ultrasonographic features including dilated intestinal length, stomach length, maximum intestinal dilatation, ratio of dilated intestinal length at late gestation and dilated stomach length (I/S ratio), and location of distal end of dilated bowel segment relative to spine were compared between CDO and high jejunal obstruction groups. The diagnostic performance of ultrasound indices was evaluated using receiver operating characteristics curve analysis. RESULTS In 25 out of 26 CDO cases, the distal end of the dilated small intestine segment was located on the right side of spine, while that in the high jejunal obstruction group was located on the left side of spine. The dilated intestinal length and I/S ratio in CDO group were significantly smaller than those in high jejunal obstruction group (p < .05). Dilated intestinal length <51 mm or I/S ratio <1 showed high sensitivity (100, 100%) and specificity (96.1, 92.3%) for CDO (area under the curve: 0.995 and 0.988, respectively). There were no significant differences in the AUCs of dilated intestinal length and I/S ratio. Significant correlation of the site of obstruction in CDO with fetal dilated intestinal length and I/S ratio (r = 0.686; 0.660, p < .001, respectively) were noted. CONCLUSION Location of the distal end of the dilated small intestine segment relative to the spine, dilated intestinal length, and I/S ratio may help differentiate fetal CDO from high jejunal obstruction. The latter two metrics were associated with the site of obstruction in CDO patients.
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Affiliation(s)
- Jinrong Liu
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yunyu Chen
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Haiyu Wang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Danping Huang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanyan Du
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaofang Liu
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiuhong Sun
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Can Yan
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenmin Chen
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongying Wang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rui Zhang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Lieu DQ, Dung TN, Long TB, Anh TN, Dung LQ, Duc NM. A rare case of Ladd's band causing duodenal occlusion in an adult with intestinal malrotation. Radiol Case Rep 2023; 18:3735-3738. [PMID: 37636537 PMCID: PMC10447930 DOI: 10.1016/j.radcr.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Abstract
A congenital defect of the fetal intestinal rotation, known as malrotation of the gut, is most often identified as an acute intestinal occlusion in early infancy. Adults with this disease tend to be asymptomatic and extremely rare. We present a case of a 47-year-old woman with duodenal obstruction due to Ladd's band admitted with acute abdominal pain and vomiting.
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Affiliation(s)
- Dau Quang Lieu
- Department of Internal Medicine, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Tran Ngoc Dung
- Department of General Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
- Department of Experimental Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Tran Bao Long
- Department of General Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
- Department of General Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Tran Ngoc Anh
- Department of Internal Medicine, Hanoi Medical University Hospital, Hanoi, Vietnam
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Luu Quang Dung
- Department of General Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Bethell GS, Long AM, Knight M, Hall NJ. Factors associated with outcomes in congenital duodenal obstruction: population-based study. Br J Surg 2023; 110:1053-1056. [PMID: 36866425 PMCID: PMC10416685 DOI: 10.1093/bjs/znad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/04/2023] [Accepted: 02/01/2023] [Indexed: 03/04/2023]
Affiliation(s)
- George S Bethell
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anna-May Long
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, Oxford, UK
- Department of Paediatric Surgery, Cambridge University Hospitals, Cambridge, UK
| | - Marian Knight
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, Oxford, UK
| | - Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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Lum Min SA, Imam M, Zrinyi A, Shawyer AC, Keijzer R. Post-discharge follow-up of congenital duodenal obstruction patients: a systematic review. Pediatr Surg Int 2023; 39:239. [PMID: 37490166 DOI: 10.1007/s00383-023-05515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Long-term follow-up of congenital duodenal obstruction patients often falls on care providers with little experience of this condition. We performed a systematic review of the long-term outcomes of duodenal obstruction and provide a summary of sequelae care providers should anticipate. METHODS In 2022, after registering with PROSPERA, Medline (Ovid), EMBASE, PSYCHINFO, CNAHL and SCOPUS databases were searched using the title keyword 'intestinal atresia'. Abstracts were filtered for inclusion if they included the duodenum. Papers of filtered abstracts were included if they reported post-discharge outcomes. Methodological Index for Non-Randomized Studies was used to grade the papers. RESULTS Of the 1068 abstracts were screened, 32 papers were reviewed. Eleven studies were included. Thirty additional papers were included after reviewing references, for a total of 41 papers. The average MINORS was 7/16. CONCLUSION There is good evidence that children with congenital duodenal obstruction do well in terms of survival, growth and general well-being. Associated cardiac, musculoskeletal and renal anomalies should be ruled-out. Care providers should be aware of anastomotic dysfunction, blind loop syndrome, bowel obstruction and reflux. Reflux may be asymptomatic. Laparoscopic repair does not change long-term outcomes, and associated Trisomy 21 worsens neurodevelopmental outcomes.
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Affiliation(s)
- Suyin A Lum Min
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Malaz Imam
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Anna Zrinyi
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Anna C Shawyer
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Richard Keijzer
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada.
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Weller JH, Engwall-Gill AJ, Westermann CR, Patel PP, Kunisaki SM, Rhee DS. Laparoscopic Versus Open Surgical Repair of Duodenal Atresia: An NSQIP-Pediatric Analysis. J Surg Res 2022; 279:803-808. [PMID: 35487775 DOI: 10.1016/j.jss.2022.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Laparoscopic repair of duodenal atresia in neonates has gained popularity among some pediatric surgeons. Single-center studies suggest comparable short-term outcomes to open surgery. The purpose of this study was to utilize a large, multi-institutional pediatric dataset to examine 30-day post-operative outcomes by operative approach for newborns who underwent duodenal atresia repairs. METHODS We identified neonates aged ≤1 wk in the 2016-2018 National Surgical Quality Improvement Program-Pediatric -database that underwent a laparoscopic or open repair for duodenal atresia. Preoperative characteristics were compared between operative approaches. Postoperative complications, operative time, postoperative length of stay (LOS), and supplemental nutrition at discharge were assessed using multivariate regressions. RESULTS There were 267 neonates who met inclusion criteria. There were 233 (87%) infants who underwent open repairs and 34 (13%) who underwent laparoscopic repairs. Ten (29%) children who had laparoscopy were converted to open. After adjusting for confounding, laparoscopy was associated with an increase in operative time by 65 min (95% confidence interval 45-87 min, P < 0.001) but a five-day shorter LOS (95% confidence interval -9 to -2, P = 0.006) when compared to laparotomy. There were no significant differences in postoperative complications or supplemental nutrition at discharge. CONCLUSIONS Our findings suggest that laparoscopic repairs of duodenal atresia are associated with shorter postoperative LOS but longer operative times when compared to open repairs. Although the conversion rate to laparotomy remained relatively high, the laparoscopic approach was associated with comparable 30-day postoperative outcomes.
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Affiliation(s)
- Jennine H Weller
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Abigail J Engwall-Gill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Carly R Westermann
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Palak P Patel
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Daniel S Rhee
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Children's Center, Baltimore, Maryland.
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10
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Deguchi K, Tazuke Y, Matsuura R, Nomura M, Yamanaka H, Soh H, Yoneda A. Factors Associated With Adverse Outcomes Following Duodenal Atresia Surgery in Neonates: A Retrospective Study. Cureus 2022; 14:e22349. [PMID: 35371797 PMCID: PMC8936229 DOI: 10.7759/cureus.22349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives There is limited evidence on the infants' postoperative complications who have undergone surgical repair of duodenal atresia and stenosis. This study aimed to identify the factors associated with poor surgical outcomes after the initial repair. Methods We retrospectively reviewed the data of 82 patients who underwent surgery for duodenal atresia and stenosis between January 1994 and December 2013 at our institution. Gestational age, birth weight, fetal growth, and other associated anomalies were recorded. Multivariate regression analyses were used to identify the factors associated with surgical outcomes, including postoperative complications and time to full oral intake. Results The median gestational age was 37.6 weeks, with 30 (37%) preterm (<37 weeks) and 11 (13%) early preterm (<34 weeks) infants. The median birth weight was 2531 g, with 27 (33%) patients < 2000 g and 10 (12%) patients < 1500 g. Postoperative surgical complications were identified in 18 (22%) cases, of which 12 (15%) required additional operations. Multivariate regression analysis revealed that a combination of very low birth weight (<1500 g) and early preterm was significantly associated with both surgical and non-surgical postoperative complications (p = 0.0028 and 0.021, respectively) and a prolonged time to full oral intake postoperatively (p = 0.013). Conclusion Very low birth weight and early preterm were significantly associated with postoperative complications and a prolonged time to full oral intake.
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11
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Patterson KN, Cruz S, Nwomeh BC, Diefenbach KA. Congenital duodenal obstruction - Advances in diagnosis, surgical management, and associated controversies. Semin Pediatr Surg 2022; 31:151140. [PMID: 35305801 DOI: 10.1016/j.sempedsurg.2022.151140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Congenital duodenal obstruction (CDO) occurs due to intrinsic and extrinsic mechanisms but is most often caused by intrinsic duodenal atresia and stenosis. This review will summarize the history, epidemiology, and etiologies associated with the most common causes of CDO. The clinical presentation, complex diagnostic considerations, and current surgical repair options for duodenal atresia and stenosis will also be discussed. Finally, both historical and recent controversies which continue to affect the surgical decision-making in the management of these patients will be highlighted.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Stephanie Cruz
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Benedict C Nwomeh
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Karen A Diefenbach
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205.
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The diagnostic accuracy of ultrasound and upper gastrointestinal contrast studies for locating atresia/stenosis and intestinal malrotation and detecting annular pancreas in pediatric patients with duodenal atresia/stenosis. J Med Ultrason (2001) 2022; 49:299-309. [PMID: 34988762 DOI: 10.1007/s10396-021-01176-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to evaluate the diagnostic performance of ultrasound to locate atresia/stenosis and other abdominal anomalies in pediatric patients with duodenal atresia/stenosis, including intestinal malrotation and annular pancreas. METHODS We classified 36 retrospective cases of duodenal atresia/stenosis based on intestinal malrotation status, and evaluated the diagnostic performance of ultrasound/upper gastrointestinal contrast studies to locate atresia/stenosis and intestinal malrotation, as well as ultrasound for detecting additional anomalies such as annular pancreas. The incidence of annular pancreas was compared between groups using Fisher's exact test. RESULTS Atresia/stenosis was correctly located by ultrasound in 33 (91.7%) cases and by upper gastrointestinal contrast study in 36 (100%) cases. Of the eight cases with intestinal malrotation, five and two were correctly diagnosed by ultrasound and upper gastrointestinal contrast study, respectively. Ultrasound correctly diagnosed annular pancreas in 6/14 cases. The incidence of annular pancreas was significantly different between the groups (present/absent in groups with vs. without intestinal malrotation: 6/2 vs. 8/20, P = 0.036). CONCLUSIONS Ultrasound has a relatively high capability in locating atresia/stenosis. However, some cases are misdiagnosed. In clinical practice, upper gastrointestinal contrast studies should be used complementarily during diagnosis. Additional anomalies may not be detected by preoperative examinations; therefore, surgeons should carefully evaluate for additional anomalies during surgery, especially coexisting intestinal malrotation and annular pancreas.
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13
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Eeftinck Schattenkerk LD, Musters GD, Nijssen DJ, de Jonge WJ, de Vries R, van Heurn LE, Derikx JP. The incidence of different forms of ileus following surgery for abdominal birth defects in infants: a systematic review with a meta-analysis method. Innov Surg Sci 2021; 6:127-150. [PMID: 35937853 PMCID: PMC9294340 DOI: 10.1515/iss-2020-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/06/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives Ileus following surgery can arise in different forms namely as paralytic ileus, adhesive small bowel obstruction or as anastomotic stenosis. The incidences of these different forms of ileus are not well known after abdominal birth defect surgery in infants. Therefore, this review aims to estimate the incidence in general between abdominal birth defects. Content Studies reporting on paralytic ileus, adhesive small bowel obstruction or anastomotic stenosis were considered eligible. PubMed and Embase were searched and risk of bias was assessed. Primary outcome was the incidence of complications. A meta-analysis was performed to pool the reported incidences in total and per birth defect separately. Summary This study represents a total of 11,617 patients described in 152 studies of which 86 (56%) had a follow-up of at least half a year. Pooled proportions were calculated as follows; paralytic ileus: 0.07 (95%-CI, 0.05-0.11; I 2=71%, p≤0.01) ranging from 0.14 (95% CI: 0.08-0.23) in gastroschisis to 0.05 (95%-CI: 0.02-0.13) in omphalocele. Adhesive small bowel obstruction: 0.06 (95%-CI: 0.05-0.07; I 2=74%, p≤0.01) ranging from 0.11 (95% CI: 0.06-0.19) in malrotation to 0.03 (95% CI: 0.02-0.06) in anorectal malformations. Anastomotic stenosis after a month 0.04 (95%-CI: 0.03-0.06; I 2=59%, p=0.30) ranging from 0.08 (95% CI: 0.04-0.14) in gastroschisis to 0.02 (95% CI: 0.01-0.04) in duodenal obstruction. Anastomotic stenosis within a month 0.03 (95%-CI 0.01-0.10; I 2=81%, p=0.02) was reviewed without separate analysis per birth defect. Outlook This review is the first to aggregate the known literature in order approximate the incidence of different forms of ileus for different abdominal birth defects. We showed these complications are common and the distribution varies between birth defects. Knowing which birth defects are most at risk can aid clinicians in taking prompt action, such as nasogastric tube placement, when an ileus is suspected. Future research should focus on the identification of risk factors and preventative measures. The incidences provided by this review can be used in those studies as a starting point for sample size calculations.
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Affiliation(s)
- Laurens D. Eeftinck Schattenkerk
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gijsbert D. Musters
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David J. Nijssen
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wouter J. de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of General, Visceral-, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, Netherlands
| | - L.W. Ernest van Heurn
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joep P.M. Derikx
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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14
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Zhou Y, Li X. Investigation of annular pancreas through multiple detector spiral CT (MDCT) and MRI. J Appl Clin Med Phys 2021; 23:e13487. [PMID: 34845829 PMCID: PMC8803292 DOI: 10.1002/acm2.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 09/01/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE To investigate annular pancreas in adults using imaging features displayed on computed tomography (CT) and magnetic resonance imaging (MRI). METHODS Retrospective review of annular pancreas in patients undergoing CT or MRI examinations. Two abdominal radiologists blindly reviewed the CT, MRI, and magnetic resonance cholangiopancreatography (MRCP) images from the Picture Archiving and Communication Systems (PACS). A Kruskal-Wallis test was performed to evaluate subjective scoring, with Mann-Whitney test for the comparison. A p-value less than 0.05 was considered statistically significant. RESULTS Eleven patients (45.8%) presented a complete ring of pancreatic tissue surrounding duodenum, displayed as circular, triangular, or sandwich sign configuration, the other 13 patients (54.2%) had incomplete annular pancreas which displayed a crocodile jaw appearance, pancreatic tissue extending in a posterolateral or anterolateral direction towards duodenum. When comparing CT images of each sequence, the arterial phase group had the highest score compared with the venous phase and the plain film group (χ2 = 58.21, p < 0.05). When comparing MRI enhancement volumetric interpolated breath-hold examination (VIBE) sequences, arterial phase group scores were the highest (χ2 = 18.98, p < 0.05). CONCLUSIONS Both CT and MRI could detect annular pancreas, with artery phase being the best sequence to diagnose annular pancreas.
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Affiliation(s)
- Yongxia Zhou
- The Yongchuan Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xiaoyan Li
- The Yongchuan Affiliated Hospital, Chongqing Medical University, Chongqing, China
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15
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Saline-Aided Ultrasound Versus Upper Gastrointestinal Series in Neonates and Infants With Suspected Upper Gastrointestinal Obstruction: A Prospective Multicenter Comparative Study. AJR Am J Roentgenol 2021; 218:526-533. [PMID: 34643106 DOI: 10.2214/ajr.21.26621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Use of upper gastrointestinal (UGI) series to diagnose UGI obstruction has raised concern in neonates and infants given increased radiation sensitivity by developing organs. Objectives: To assess the diagnostic performance of saline-aided ultrasound for UGI obstruction in neonates and infants, in comparison with UGI series. Methods: This prospective multicenter study enrolled inpatients at three hospitals who were less than 1 year old and had suspected UGI obstruction between June 2015 and May 2018; patients with malrotation or pyloric stenosis on ultrasound were ineligible. Enrolled patients underwent both saline-aided ultrasound (saline administered by nasogastric tube) and UGI series. Surgical findings or at least one-year clinical follow-up served as reference for presence of UGI obstruction. Patients with UGI obstruction were classified in terms of level (proximal vs distal) and cause. Two radiologists independently interpreted saline-aided US examinations to assess interobserver agreement and then reached consensus. Two separate radiologists assessed upper GI series in consensus. Diagnostic performance for UGI obstruction presence and level was compared between modalities. Causes were assessed on saline-aided ultrasound. Results: A total of 209 neonates were included (median age 5 days; 116 male, 93 female); 124 (59.3%) had UGI obstruction (proximal in 108). Saline-aided ultrasound exhibited strong interobserver agreement for obstruction presence (κ=0.87) and level (κ=0.85). For presence of UGI obstruction, accuracy, sensitivity, and specificity were 94.7%, 98.4%, and 89.4% for saline-aided US, versus 89.5%, 95.2%, and 81.5% for UGI series. For obstruction level, accuracy, sensitivity, and specificity were 91.9%, 97.2%, and 56.3% for saline-aided US, versus 87.1%, 92.6%, and 50.0% for UGI series. Accuracy for presence was significantly higher for saline-aided US (p=.02); otherwise, these metrics were not different between tests (p>.05). For causes of UGI obstruction (annual pancreas, duodenal web, duodenal atresia, and duodenal stenosis), accuracy of saline-aided US ranged from 75.0% to 94.1%. Conclusion: Saline-aided US has high diagnostic performance for presence and level of UGI obstruction in neonates and infants, comparing favorably versus UGI series. Saline-aided US may have additional utility in evaluating causes of obstruction. Clinical Impact: Saline-aided US may serve as an initial screening modality for UGI obstruction in neonates and infants.
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16
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Eeftinck Schattenkerk LD, Musters GD, Nijssen DJ, de Jonge WJ, de Vries R, van Heurn LWE, Derikx JPM. The incidence of abdominal surgical site infections after abdominal birth defects surgery in infants: A systematic review with meta-analysis. J Pediatr Surg 2021; 56:1547-1554. [PMID: 33485614 DOI: 10.1016/j.jpedsurg.2021.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Surgical site infections (SSI) are a frequent and significant problem understudied in infants operated for abdominal birth defects. Different forms of SSIs exist, namely wound infection, wound dehiscence, anastomotic leakage, post-operative peritonitis and fistula development. These complications can extend hospital stay, surge medical costs and increase mortality. If the incidence was known, it would provide context for clinical decision making and aid future research. Therefore, this review aims to aggregate the available literature on the incidence of different SSIs forms in infants who needed surgery for abdominal birth defects. METHOD The electronic databases Pubmed, EMBASE, and Cochrane library were searched in February 2020. Studies describing infectious complications in infants (under three years of age) were considered eligible. Primary outcome was the incidence of SSIs in infants. SSIs were categorized in wound infection, wound dehiscence, anastomotic leakage, postoperative peritonitis, and fistula development. Secondary outcome was the incidence of different forms of SSIs depending on the type of birth defect. Meta-analysis was performed pooling reported incidences in total and per birth defect separately. RESULTS 154 studies, representing 11,786 patients were included. The overall pooled percentage of wound infections after abdominal birth defect surgery was 6% (95%-CI:0.05-0.07) ranging from 1% (95% CI:0.00-0.05) for choledochal cyst surgery to 10% (95%-CI:0.06-0.15) after gastroschisis surgery. Wound dehiscence occurred in 4% (95%-CI:0.03-0.07) of the infants, ranging from 1% (95%-CI:0.00-0.03) after surgery for duodenal obstruction to 6% (95%-CI:0.04-0.08) after surgery for gastroschisis. Anastomotic leakage had an overall pooled percentage of 3% (95%-CI:0.02-0.05), ranging from 1% (95%-CI:0.00-0.04) after surgery for duodenal obstruction to 14% (95% CI:0.06-0.27) after colon atresia surgery. Postoperative peritonitis and fistula development could not be specified per birth defect and had an overall pooled percentage of 3% (95%-CI:0.01-0.09) and 2% (95%-CI:0.01-0.04). CONCLUSIONS This review has systematically shown that SSIs are common after correction for abdominal birth defects and that the distribution of SSI differs between birth defects.
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Affiliation(s)
- Laurens D Eeftinck Schattenkerk
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Gijsbert D Musters
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands
| | - David J Nijssen
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands
| | - Wouter J de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of General, Visceral, Thoracic, and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - L W Ernest van Heurn
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joep P M Derikx
- Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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17
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Guelfand M, Harding C. Laparoscopic Management of Congenital Intestinal Obstruction: Duodenal Atresia and Small Bowel Atresia. J Laparoendosc Adv Surg Tech A 2021; 31:1185-1194. [PMID: 34357817 DOI: 10.1089/lap.2021.0395] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Congenital intestinal obstruction occurs in ∼1:2000 live births. Congenital duodenal atresia and duodenal stenosis are frequent causes of intestinal obstruction and occur in 1 per 5000-10,000 live births. Today, duodeno-duodeno anastomosis is still the treatment of choice, and it can be performed safely by minimally invasive surgery, although duodenojejunal anastomosis is surgically simpler and has equal results. Jejunum-ileal atresia or stenosis is a major cause of neonatal intestinal obstruction; its prevalence is 1:330-1:1500 live births. Nowadays, the ability of laparoscopic assisted identification of the atresia and repair by only exteriorization of the small bowel through the umbilicus makes this technique safe and feasible in almost every new born. Methods: This article will describe the operative technique of laparoscopic management of congenital duodenal and small bowel obstruction. Results: For congenital duodenal atresia patients, mortality rate is less than 5% and the majority are secondary to associated comorbidities. There is a low rate of anastomotic leaks, anastomotic stricture, delayed gastric emptying, and bacterial overgrowth. For small bowel atresia patients, complications include anastomotic leak, adhesions, small bowel obstruction, and short bowel syndrome in less than 5% of the patients. The rate of re-operations due to small bowel obstruction in laparoscopic assisted repair patients is less compared with laparotomy patients. Conclusions: Minimally invasive surgery for duodenal and small bowel atresia is safe and feasible and reduces the complications of open surgical procedures.
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Affiliation(s)
- Miguel Guelfand
- Department of Pediatric Surgery, Hospital Dr. Exequiel González Cortés, Santiago, Chile, Guelfand, Harding.,Department of Pediatric Surgery, Universidad de Chile. Guelfand.,Department of Pediatric Surgery, Clínica Las Condes, Santiago, Chile, Guelfand
| | - Constanza Harding
- Department of Pediatric Surgery, Hospital Dr. Exequiel González Cortés, Santiago, Chile, Guelfand, Harding
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18
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Kozlov YA, Rasputin AA, Baradieva PA, Cheremnov VS, Ochirov CB, Zvonkov DA, Kovalkov KA, Poloyan SS, Chubko DM, Kapuller VM, Vinogradov KA. [Multiple-center study of laparoscopic and open treatment of duodenal atresia]. Khirurgiia (Mosk) 2021:5-13. [PMID: 33977692 DOI: 10.17116/hirurgia20210515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To summarize data of a multiple-center study of the treatment of duodenal atresia in 3 children's hospitals of the Siberian Federal District. MATERIAL AND METHODS We analyzed postoperative outcomes in 211 patients with duodenal atresia. All patients underwent surgery at various hospitals of the Siberian Federal District: Ivano-Matreninsky Children's Clinical Hospital in Irkutsk (expert hospital) - 120 patients; Center for Maternal and Child Welfare in Krasnoyarsk (learning hospital No. 1) - 51 patients; Kemerovo Regional Children's Clinical Hospital (learning hospital No. 2) - 40 patients. The study has been carried out for 15 years (from January 2005 and to December 2019). Patients were divided into 2 cohorts: group I - 88 patients (laparoscopic formation of duodenal anastomosis); group II - 123 patients (surgery via laparotomy). Demographic data, intra- and postoperative parameters and complications were analyzed. RESULTS Preoperative parameters were similar in both groups. Significant between-group differences were found for surgery time (70 vs. 90 min; p<0.001). Initiation of feeding and complete enteral nutrition occurred significantly earlier after laparoscopy (3 vs. 7 days, p<0.001 and 8 vs. 12 days, p<0.001). Incidence of anastomotic leakage significantly differed in both groups (1 patient after laparoscopy and 9 patients after laparotomy, p=0.038). Mortality was absent in the laparoscopy group. In the laparotomy group, this value was 4.9% (p=0.036) and caused by concomitant conditions (prematurity, sepsis, heart defects). Late postoperative complications (adhesive intestinal obstruction, ventral hernias) were absent after laparoscopy and occurred in 5.7% of patients after laparotomy (p=0.023). CONCLUSION Laparoscopic correction of duodenal atresia can be safely performed by experienced endoscopic surgeons from different centers united by the same ideology of endoscopic surgery. Laparoscopy ensures less duration of surgery, faster postoperative recovery, less mortality, incidence of early and late postoperative complications.
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Affiliation(s)
- Yu A Kozlov
- Irkutsk Municipal Pediatric Clinical Hospital, Irkutsk, Russia.,Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.,Irkutsk State Medical University, Irkutsk, Russia
| | - A A Rasputin
- Irkutsk Municipal Pediatric Clinical Hospital, Irkutsk, Russia
| | - P A Baradieva
- Irkutsk Municipal Pediatric Clinical Hospital, Irkutsk, Russia
| | - V S Cheremnov
- Irkutsk Municipal Pediatric Clinical Hospital, Irkutsk, Russia
| | - Ch B Ochirov
- Irkutsk Municipal Pediatric Clinical Hospital, Irkutsk, Russia
| | - D A Zvonkov
- Irkutsk Municipal Pediatric Clinical Hospital, Irkutsk, Russia
| | - K A Kovalkov
- Kemerovo Regional Clinical Pediatric Hospital, Kemerovo, Russia
| | - S S Poloyan
- Center for Maternal and Child Welfare, Krasnoyarsk, Russia
| | - D M Chubko
- Center for Maternal and Child Welfare, Krasnoyarsk, Russia
| | - V M Kapuller
- Hadassah University's Medical Center, Jerusalem, Israel
| | - K A Vinogradov
- Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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19
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Makkadafi M, Fauzi AR, Wandita S, Makhmudi A, Gunadi. Outcomes and survival of infants with congenital duodenal obstruction following Kimura procedure with post-anastomosis jejunostomy feeding tube. BMC Gastroenterol 2021; 21:100. [PMID: 33663393 PMCID: PMC7934461 DOI: 10.1186/s12876-021-01679-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 02/18/2021] [Indexed: 12/17/2022] Open
Abstract
Background Several modifications of the Kimura procedure for congenital duodenal obstruction (CDO) have been reported, however, their effects on the outcomes show conflicting results.
Methods We compared the CDO outcomes following the Kimura procedure with and without post-anastomosis jejunostomy feeding tube (JFT). Results A total of 52 CDO neonates were involved (JFT: 13 males and 2 females vs. non-JFT: 14 males and 23 females, p = 0.0019). Time to full oral feeding was significantly earlier in the JFT than non-JFT group (14 [interquartile range (IQR), 12–15] vs. 17 [IQR, 14–22.5] days; p = 0.04). Duration of parenteral nutrition given to infants with CDO after surgery was significantly shorter in the JFT than non-JFT group (12 [IQR, 10–15] vs. 17 [IQR, 13–23] days; p = 0.031). Moreover, enteral feeding was significantly earlier in the JFT than non-JFT group (2 [IQR, 1–3.5] vs. 5 [IQR, 4–6] days; p = < 0.0001). However, the length of stay following surgery was not significantly different between groups (16 [IQR, 14–22] vs. 20 [IQR, 17–28] days; p = 0.22). Also, overall patient survival did not significantly differ between JFT (66.7%) and non-JFT patients (59.5%) (p = 0.61). Conclusion Jejunostomy feeding tube shows a beneficial effect on the time to full oral feeding, duration of parenteral nutrition and early enteral feeding in neonates with congenital duodenal obstruction after Kimura procedure.
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Affiliation(s)
- Munawir Makkadafi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia.,Department of Surgery, Faculty of Medicine, Hasanuddin University/RSUP Dr. Tadjuddin Chalid, Makassar, South Sulawesi, 90245, Indonesia
| | - Aditya Rifqi Fauzi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia
| | - Setya Wandita
- Neonatology Division, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Akhmad Makhmudi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia
| | - Gunadi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia.
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20
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Demirci O, Eriç Özdemir M, Kumru P, Celayir A. Clinical significance of prenatal double bubble sign on perinatal outcome and literature review. J Matern Fetal Neonatal Med 2021; 35:1841-1847. [PMID: 33455511 DOI: 10.1080/14767058.2021.1874338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of the double bubble sign in predicting duedonal obstruction, the prevalence of anomalies associated with congenital duedonal obstruction, and to evaluate the outcome of these pregnancies and review the literature. METHODS We analyzed that the cases with double bubble sign were detected in prenatal ultrasonography between January 2014 and December 2019. Ultrasound reports, karyotyping results, surgical confirmed diagnoses and long-term results were extracted from the hospital database. RESULTS Duodenal obstruction was detected in all operated cases with double bubble sign detected in prenatal ultrasonography. Karyotype anomaly was found in 63.9% and additional congenital anomaly was found in 69.4%. Adverse perinatal outcome was seen in 51.1% of cases. Adverse perinatal outcome was found significantly higher in abnormal karyotype and congenital anomaly groups than isolated group. 81.8% of the isolated cases lived after the operation. Only two isolated cases died. CONCLUSION The prenatal double bubble sign is a highly reliable predictor for duodenal obstruction and structural anomalies and/or genetic abnormalities are present in the majority of cases. Duodenal obstruction is isolated, the outcomes appear favorable.
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Affiliation(s)
- Oya Demirci
- Perinatology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Mucize Eriç Özdemir
- Perinatology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Pınar Kumru
- Perinatology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Aysenur Celayir
- Pediatric Surgery Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
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21
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Yang B, Huang D, Zhou L, Zhong W, He Q, Wang Z, Fang Q, Wang H. The value of saline-aided ultrasound in diagnosing congenital duodenal obstruction. Pediatr Surg Int 2020; 36:1197-1203. [PMID: 32715324 DOI: 10.1007/s00383-020-04723-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study is to assess the value of saline-aided ultrasound (US) in diagnosing congenital duodenal obstruction (CDO). METHODS The neonates with CDO were enrolled in this study, including the neonates confirmed with annular pancreas (AP) by operation, the neonates confirmed with duodenal atresia, the neonates confirmed with duodenum web, and the neonates confirmed with malrotation. Pertinent data were recorded, including the US features, intraoperative findings, and surgical procedures. The methodology of this study is a diagnostic test study which means the US feature is the test and the intraoperative finding is the gold standard. RESULTS A total of 95 neonates were enrolled, including 33 neonates with AP, 6 neonates with duodenal atresia, 29 neonates with duodenum web, and 27 neonates with malrotation. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the hyperechogenic band for the detection of AP were 78.8% (26/33), 90.3% (56/62), 81.2% (26/32), 88.8% (56/63), and 86.3% (82/95), respectively. The sensitivity, specificity, NPV, and accuracy for the detection of duodenal atresia were 0% (0/6), 100% (89/89), 93.6% (89/95), and 93.6% (89/95), respectively. The sensitivity, specificity, PPV, NPV, and accuracy for the detection of duodenum web were 100% (29/29), 100% (66/66), 100% (29/29), 100% (66/66), and 100% (95/95), respectively. The sensitivity, specificity, PPV, NPV, and accuracy for the detection of malrotation were 100% (27/27), 100% (68/68), 100% (27/27), 100% (68/68), and 100% (95/95), respectively. CONCLUSION Saline-aided US is a feasible tool to diagnose CDO.
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Affiliation(s)
- Boyang Yang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 of Jin Sui Road, Guangzhou, 510623, China
| | - Danping Huang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 of Jin Sui Road, Guangzhou, 510623, China
| | - Luyao Zhou
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Wei Zhong
- Department of Neonatal Surgery and Neonatal Surgical Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Qiuming He
- Department of Neonatal Surgery and Neonatal Surgical Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Zhe Wang
- Department of Neonatal Surgery and Neonatal Surgical Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Qian Fang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 of Jin Sui Road, Guangzhou, 510623, China
| | - Hongying Wang
- Department of Medical Ultrasonics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 of Jin Sui Road, Guangzhou, 510623, China.
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22
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No way out: Causes of duodenal and gastric outlet obstruction. Clin Imaging 2020; 65:37-46. [DOI: 10.1016/j.clinimag.2020.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 11/17/2022]
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23
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Yin C, Tong L, Ma M, Tan X, Luo G, Fei Z, Nie D. The application of prenatal ultrasound in the diagnosis of congenital duodenal obstruction. BMC Pregnancy Childbirth 2020; 20:387. [PMID: 32620086 PMCID: PMC7333320 DOI: 10.1186/s12884-020-03078-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/24/2020] [Indexed: 12/05/2022] Open
Abstract
Background The purpose of this research is to summarize the prenatal ultrasound characteristics of congenital duodenal obstruction (CDO), especially in the diagnosis of duodenal diaphragm and annular pancreas. At present, few researchers have summarized the specific ultrasound features of duodenal diaphragm and annular pancreas. Methods In this study, a retrospective analysis of 40 patients diagnosed with CDO between January 2016 and December 2019 was carried out. Data on the diagnosis, ultrasound images and outcomes of the patients were gathered, and the features of the patients were analyzed. Results The results showed that there were 17 patients (42.5%) of congenital duodenal diaphragm, all with a ‘rat tail’ sign on the ultrasound images. Moreover, there were 4 patients (10.0%) of CDO caused by annular pancreas, all with a ‘pliers’ sign on the ultrasound images. We summarized the imaging features of the ‘rat tail’ sign and the ‘pliers’ sign. Conclusion The main conclusion of this study was that the ‘rat tail’ sign could be used as an indirect ultrasound feature to diagnose duodenal diaphragm. The ‘pliers’ sign could be used as a direct ultrasound feature in the diagnosis of annular pancreas in CDO.
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Affiliation(s)
- Chan Yin
- The Maternal and Child Health Hospital of Changde city, Changde, 415000, China
| | - Lili Tong
- The Maternal and Child Health Hospital of Changde city, Changde, 415000, China
| | - Mingxiang Ma
- The Maternal and Child Health Hospital of Changde city, Changde, 415000, China
| | - Xiaoqun Tan
- The Maternal and Child Health Hospital of Changde city, Changde, 415000, China
| | - Guoliang Luo
- The Maternal and Child Health Hospital of Taoyuan city, Taoyuan, 415700, China
| | - Zhihui Fei
- The Maternal and Child Health Hospital of Changde city, Changde, 415000, China
| | - Dan Nie
- The Maternal and Child Health Hospital of Changde city, Changde, 415000, China.
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24
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Wani SA, Rashid KA, Saxena K, Khan M. Atypical presentation of concurrent duodenal web and malrotation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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25
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Bethell GS, Long AM, Knight M, Hall NJ. Congenital duodenal obstruction in the UK: a population-based study. Arch Dis Child Fetal Neonatal Ed 2020; 105:178-183. [PMID: 31229958 PMCID: PMC7063389 DOI: 10.1136/archdischild-2019-317085] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Congenital duodenal obstruction (CDO) comprising duodenal atresia or stenosis is a rare congenital anomaly requiring surgical correction in early life. Identification of variation in surgical and postoperative practice in previous studies has been limited by small sample sizes. This study aimed to prospectively estimate the incidence of CDO in the UK, and report current management strategies and short-term outcomes. DESIGN Prospective population-based, observational study for 12 months from March 2016. SETTING Specialist neonatal surgical units in the UK. MAIN OUTCOME MEASURES Incidence of CDO, associated anomalies and short-term outcomes. RESULTS In total, 110 cases were identified and data forms were returned for 103 infants giving an estimated incidence of 1.22 cases per 10 000 (95% CI 1.01 to 1.49) live births. Overall, 59% of cases were suspected antenatally and associated anomalies were seen in 69%. Operative repair was carried out mostly by duodenoduodenostomy (76%) followed by duodenojejunostomy (15%). Postoperative feeding practice varied with 42% having a trans-anastomotic tube placed and 88% receiving parenteral nutrition. Re-operation rate related to the initial procedure was 3% within 28 days. Two infants died within 28 days of operation from unrelated causes. CONCLUSION This population-based study of CDO has shown that the majority of infants have associated anomalies. There is variation in postoperative feeding strategies which represent opportunities to explore the effects of these on outcome and potentially standardise approach. Short-term outcomes are generally good.
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Affiliation(s)
- George Stephen Bethell
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anna-May Long
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford, UK,Department of Paediatric Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford, UK
| | - Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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26
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Hsu YC, Yen HH. An unusual cause of recurrent vomiting. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2019; 30:1062-1063. [PMID: 31854312 PMCID: PMC6924597 DOI: 10.5152/tjg.2019.19001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/25/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Yu-Chun Hsu
- Department of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsu-Heng Yen
- Department of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan
- General Education Center, Chienkuo Technology University, Changhua, Taiwan
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27
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WANG L, XUE J, CHEN Y, LYU C, HUANG S, TOU J, GAO Z, CHEN Q. [Clinical analysis of annular pancreas in neonates]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:481-486. [PMID: 31901020 PMCID: PMC8800762 DOI: 10.3785/j.issn.1008-9292.2019.10.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To analyze clinical manifestations, diagnosis and treatment of annular pancreas in neonates. METHODS Clinical data of 114 neonates with annular pancreas admitted in the Children's Hospital of Zhejiang University from January 2009 to December 2018 were reviewed. The demographic parameters (gestational age, birth weight), clinical manifestations, onset time, results of antenatal examination, associated anomalies, radiological findings, operations, postoperative complications were analyzed. RESULTS One hundred and two cases were examined by abdominal echography, in which 68 cases showed duodenal obstruction, 4 cases showed annular pancreas. Plain abdomen X-ray examination performed in 113 cases before operation, 76 cases presented double-bubble sign, 12 cases presented single-bubble sign and 5 cases had high-position intestinal obstruction. Upper gastrointestinal radiography (UGI) was performed in 103 cases, which suggested duodenal obstruction in 102 cases. Operations were performed in all cases, of which 69 cases were operated under laparoscopy including 1 case converted to open laparotomy. The mean fasting time after surgery was (7.8±2.7) d, and the mean length of hospital stay was (16.9±10.1) d. Five patients had postoperative complications. The incidence of postoperative complications in antenatal abnormal group was lower than that in the antenatal non-abnormal group (P<0.05); the average fasting time in laparoendscopic surgery group was shorter than that in traditional laparotomy group (P<0.05). CONCLUSIONS Neonates with recurrent vomiting early after birth should be highly suspected to have annular pancreas. The fetal chromosome examination should be performed with abnormal antenatal screening. Surgery is the only effective way to diagnose and treat annular pancreas, and laparoscopic surgery could be the first choice for experienced doctors.
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Affiliation(s)
| | | | | | | | | | | | | | - Qingjiang CHEN
- 陈青江(1976—), 男, 博士, 副主任医师, 主要从事小儿普通外科研究; E-mail:
;
https://orcid.org/0000-0003-0025-7554
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28
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Forster C, Zamiara P, Lapidus-Krol E, Chiang M, Scaini V, Haliburton B, Moore AM, Marcon MA, Chiu PPL. Outcomes of multi-gestational pregnancies affected by esophageal atresia - tracheoesophageal fistula. J Pediatr Surg 2019; 54:2080-2083. [PMID: 31103274 DOI: 10.1016/j.jpedsurg.2019.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/28/2019] [Accepted: 04/28/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Contemporary outcomes of infants with esophageal atresia with or without tracheoesophageal fistula (EA/TEF) from multi-gestational pregnancies compared to those of singleton pregnancies have not been reported. METHODS A single-center retrospective review of EA/TEF patients born from 1999 to 2013 was performed. Patient demographics, gestational age (GA), birth weight, associated anomalies, requirement for gastrostomy tube and mortality were reviewed. RESULTS Singleton EA/TEF patients outnumbered those from multi-gestational pregnancies nearly 10:1 (214 vs 22 patients). EA/TEF patients from multi-gestational pregnancies were more likely to be premature (77% vs. 32%), have lower birth weight (mean 1766 g vs. 2695 g), have associated duodenal atresia (18% vs. 6%) and require gastrostomy tube (41% vs. 33%) for feeding challenges compared to EA/TEF singletons. Mortality was also significantly greater for multi-gestational EA/TEF patients compared to singleton EA/TEF patients (18% vs. 6%). CONCLUSION EA/TEF infants from multi-gestational pregnancies have greater clinical complexity and mortality than singleton EA/TEF patients. Parents of EA/TEF multi-gestational infants should be appropriately counseled and supported.
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Affiliation(s)
- Corey Forster
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Paul Zamiara
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Eveline Lapidus-Krol
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Monping Chiang
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vikki Scaini
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Beth Haliburton
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Aideen M Moore
- Division of Neonatology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Priscilla P L Chiu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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29
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Goh MFJ, Mak MHW, Low Y, Ong CCP. Congenital or acquired? Obstructive jaundice in reoperated duodenal atresia. BMJ Case Rep 2019; 12:12/8/e231021. [PMID: 31466956 DOI: 10.1136/bcr-2019-231021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 55-day-old boy was transferred to our unit with intestinal obstruction and obstructive jaundice after two neonatal operations for duodenal atresia and intestinal malrotation. Abdominal ultrasound showed dilated intrahepatic and extrahepatic ducts with cut-off at the distal common bile duct (CBD). He underwent emergency laparotomy for adhesive intestinal obstruction with a contained abscess from mid-jejunal perforation. Biliary dissection was not attempted due to poor preoperative nutritional status. Tube cholecystostomy was created for biliary decompression. Postoperative magnetic resonance cholangiopancreatography showed dilated CBD with cut-off at the ampulla but did not demonstrate pancreaticobiliary maljunction (PBMJ). The diagnostic dilemma was whether our patient had congenital PBMJ or had developed biliary stricture from perioperative ischaemic scarring. He underwent definitive surgery at 7 months: excision of dilated CBD with Roux-en-Y hepaticojejeunal reconstruction, excisional tapering duodenoplasty and jejunostomy creation. Intraoperative finding was type I choledochal cyst and subsequently confirmed on histology. Postoperative recovery was uneventful and bilirubin levels normalised.
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Affiliation(s)
| | | | - Yee Low
- Paediatric Surgery, KK Women's and Children's Hospital, Singapore
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30
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Gfroerer S, Theilen TM, Fiegel HC, Esmaeili A, Rolle U. Comparison of outcomes between complete and incomplete congenital duodenal obstruction. World J Gastroenterol 2019; 25:3787-3797. [PMID: 31391773 PMCID: PMC6676550 DOI: 10.3748/wjg.v25.i28.3787] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/13/2019] [Accepted: 07/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes. AIM To quantify and compare the association between CCDO and ICDO with outcome parameters. METHODS We retrospectively reviewed all patients who underwent operative repair of CCDO or ICDO in our tertiary care institution between January 2004 and January 2017. The demographics, clinical presentation, preoperative diagnostics and postoperative outcomes of 50 patients were compared between CCDO (n = 27; atresia type 1-3, annular pancreas) and ICDO (n = 23; annular pancreas, web, Ladd´s bands). RESULTS In total, 50 patients who underwent CDO repair were enrolled and followed for a median of 5.2 and 3.9 years (CCDO and ICDO, resp.). CCDO was associated with a significantly higher prenatal ultrasonographic detection rate (88% versus 4%; CCDO vs ICDO, P < 0.01), lower gestational age at birth, lower age and weight at operation, higher rate of associated congenital heart disease (CHD), more extensive preoperative radiologic diagnostics, higher morbidity according to Clavien-Dindo classification and comprehensive complication index (all P ≤ 0.01). The subgroup analysis of patients without CHD and prematurity showed a longer time from operation to the initiation of enteral feeds in the CCDO group (P < 0.01). CONCLUSION CCDO and ICDO differ with regard to prenatal detection rate, gestational age, age and weight at operation, rate of associated CHD, preoperative diagnostics and morbidity. The degree of CDO in mature patients without CHD influences the postoperative initiation of enteral feeding.
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Affiliation(s)
- Stefan Gfroerer
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Frankfurt 60590, Germany
| | - Till-Martin Theilen
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Frankfurt 60590, Germany
| | - Henning C Fiegel
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Frankfurt 60590, Germany
| | - Anoosh Esmaeili
- Department of Pediatric Cardiology, University Hospital Frankfurt, Frankfurt 60590, Germany
| | - Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Frankfurt 60590, Germany
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31
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Bengtsson BOS, Lee S, Houten JPV, Stolar CJ. Three laparotomies later: extrinsic duodenal atresia from malrotation complicated by intrinsic duodenal and pyloric windsock webs. CASE REPORTS IN PERINATAL MEDICINE 2019. [DOI: 10.1515/crpm-2018-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
We present a term infant with the unusual findings of malrotation in combination with both duodenal and pyloric webs of windsock type, thus masquerading as postoperative bowel dysfunction and ultimately requiring three laparotomies. To the best of our knowledge these three findings in combination have not been previously reported. The dilemma of whether to perform a duodenotomy or not during malrotation repair and the importance of instrumenting the intestine from the duodenotomy site in both retrograde and antegrade directions are discussed.
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Affiliation(s)
- Bengt-Ola S. Bengtsson
- Pediatrix Medical Group of California, Department of Pediatrics, Neonatal Intensive Care Unit , Community Memorial Hospital of San Buenaventura , 147 N. Brent Street , Ventura, CA 93003 , USA
- Clinical assistant professor of pediatrics , Western University of Health Sciences, College of Osteopathic Medicine of the Pacific , Pomona, CA , USA
| | - Sang Lee
- California Pediatric Surgical Group , Goleta, CA , USA
| | - John P. van Houten
- Pediatrix Medical Group of California, Department of Pediatrics, Neonatal Intensive Care Unit , Community Memorial Hospital of San Buenaventura , 147 N. Brent Street , Ventura, CA 93003 , USA
- Clinical assistant professor of pediatrics , Western University of Health Sciences, College of Osteopathic Medicine of the Pacific , Pomona, CA , USA
| | - Charles J.H. Stolar
- California Pediatric Surgical Group , Goleta, CA , USA
- Rudolph N Schullinger Emeritus Professor of Surgery and Pediatrics , Columbia University , New York, NY , USA
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32
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Diagnostic value of the acute angle between the prestenotic and poststenotic duodenum in neonatal annular pancreas. Eur Radiol 2019; 29:2902-2909. [DOI: 10.1007/s00330-018-5922-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/30/2018] [Accepted: 11/28/2018] [Indexed: 12/13/2022]
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33
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Duodenal atresia and associated intestinal atresia: a cohort study and review of the literature. Pediatr Surg Int 2019; 35:151-157. [PMID: 30386906 DOI: 10.1007/s00383-018-4387-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE To determine the true incidence of associated intestinal atresia (AIA) in infants with duodenal atresia (DA) and to analyze whether the surgical approach, open versus laparoscopic, would impact on patient outcome when AIA is present. METHODS Cohort study We review all DA infants treated at our institution (2001-2016) and analyzed the outcome of those with AIA. Systematic review/meta-analysis Using a defined search strategy and according to PRISMA guidelines, two investigators independently identified all studies on DA and searched cases of AIA to determine its incidence. Data are mean ± SD. RESULTS Cohort study Of 140 DA infants, 10 (7%) had AIA (4 type I, 4 type III, 2 type II). All type I AIA (webs) were found in the duodenum. Systematic review/meta-analysis Of 840 studies, 18 were included (2026 infants). The incidence of AIA was 2.8 ± 1.6%. The incidence of missed AIA was 0.8 ± 2.4%. Three comparative studies (759 infants) showed higher risk of missed AIA following laparoscopic (2.9 ± 2.4%) than open repair (0.3 ± 0.1%; p < 0.01). CONCLUSIONS The incidence of AIA in DA infants is low and the risk of missing it is higher at laparoscopy than at laparotomy. Regardless the approach, surgeons should carefully investigate bowel continuity to avoid the risk of missing AIA.
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34
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Jacobs C, Khan FA, Apple C, Larson SD. Duodenal web presenting outside the neonatal period concurrently with malrotation and mid-gut volvulus. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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35
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Huang LY, Zhen L, Pan M, Han J, Yang X, Li DZ. Application of noninvasive prenatal testing in pregnancies with fetal double bubble sign: Is it feasible? Prenat Diagn 2018; 38:402-405. [PMID: 29575086 DOI: 10.1002/pd.5248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the application of noninvasive prenatal testing as an alternative to invasive diagnostic testing in pregnancies with the double bubble sign. METHODS This was a retrospective analysis of 92 pregnancies with fetal double bubble identified by prenatal ultrasound, in which invasive diagnostic testing was performed for genetic investigations using quantitative fluorescence PCR and chromosomal microarray. Noninvasive prenatal testing was assumed to provide to patients for screening for the common aneuploidies. RESULTS Fetal trisomy 21 was detected in 8 of the 92 patients with prenatal double bubble. No other chromosomal anomalies or microscopic pathogenic copy-number variations (CNV) were found. Noninvasive prenatal testing could theoretically identified the affected pregnancies with trisomy 21 in this group with decreased number of invasive diagnostic testing. CONCLUSIONS Noninvasive prenatal testing could be recommended for genetic evaluation of the etiology of prenatal double bubble after thorough pretest counseling.
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Affiliation(s)
- Lv-Yin Huang
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Zhen
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Min Pan
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jin Han
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xin Yang
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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36
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Cairo S, Kakembo N, Kisa P, Muzira A, Cheung M, Healy J, Ozgediz D, Sekabira J. Disparity in access and outcomes for emergency neonatal surgery: intestinal atresia in Kampala, Uganda. Pediatr Surg Int 2017; 33:907-915. [PMID: 28677072 DOI: 10.1007/s00383-017-4120-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Intestinal atresia is one of the leading causes of neonatal intestinal obstruction (NIO). The purpose of this study was to analyze the presentation and outcome of IA and compare with those from both similar and high-income country settings. PATIENTS AND METHODS A retrospective review of prospectively collected data from patient charts and pediatric surgical database for 2012-2015 was performed. Epidemiological data and patient characteristics were analyzed and outcomes were compared with those reported in other LMICs and high-income countries (HICs). Unmet need was calculated along with economic valuation or economic burden of surgical disease. RESULTS Of 98 patients, 42.9% were male. 35 patients had duodenal atresia (DA), 60 had jejunio-ileal atresia (JIA), and 3 had colonic atresia. The mean age at presentation was 7.14 days for DA and 6.7 days for JIA. Average weight for DA and JIA was 2.2 and 2.12 kg, respectively. All patients with DA and colonic atresia underwent surgery, and 88.3% of patients with JIA had surgery. Overall mortality was 43% with the majority of deaths attributable to aspiration, anastomotic leak, and sepsis. 3304 DALYs were calculated as met compared to 25,577 DALYs' unmet. CONCLUSION Patients with IA in Uganda present late in the clinical course with high morbidity and mortality attributable to a combination of late presentation, poor nutrition status, surgical complications, and likely underreporting of associated anomalies rather than surgical morbidity alone. LEVEL OF EVIDENCE Level IV, Case series with no comparison group.
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Affiliation(s)
- Sarah Cairo
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA.
| | - Nasser Kakembo
- Department of Surgery, Mulago-Makerere University Teaching Hospital, Kampala, Uganda
| | - Phyllis Kisa
- Department of Surgery, Mulago-Makerere University Teaching Hospital, Kampala, Uganda
| | - Arlene Muzira
- Department of Surgery, Mulago-Makerere University Teaching Hospital, Kampala, Uganda
| | - Maija Cheung
- Department of Pediatric Surgery, Yale School of Medicine, New Haven, USA
| | - James Healy
- Department of Pediatric Surgery, Yale School of Medicine, New Haven, USA
| | - Doruk Ozgediz
- Department of Pediatric Surgery, Yale School of Medicine, New Haven, USA
- Global Partners in Anesthesia and Surgery (GPAS), Kampala, Uganda
| | - John Sekabira
- Department of Pediatric Surgery, Yale School of Medicine, New Haven, USA
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Yhoshu E, Mahajan JK. Use of Simultaneous Nasogastric and Nasojejunal Tubes for Proximal Intestinal Atresias - A Preliminary Report. J Neonatal Surg 2017; 6:51. [PMID: 28770148 PMCID: PMC5538615 DOI: 10.21699/jns.v6i2.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/11/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Enono Yhoshu
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh India 160012
| | - J K Mahajan
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh India 160012
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38
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Musapudi EM, Mujinga DT, Ilunga GN. [Neonatal obstruction associated with duodenal diaphragm: about a case]. Pan Afr Med J 2017; 25:85. [PMID: 28292048 PMCID: PMC5324162 DOI: 10.11604/pamj.2016.25.85.9871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/20/2016] [Indexed: 11/17/2022] Open
Abstract
Le diaphragme duodénal est l’une de rare forme d’atrésie duodénale décrite, qui provoque l’occlusion intestinale pendant la période néonatale. La cause est embryologique. Les auteurs rapportent le cas d’un nouveau-né de 17 jours, hospitalisé et prise en charge aux cliniques universitaires de Lubumbashi pour occlusion duodénale et dont le constat per opératoire était un diaphragme duodénal. Son évolution était bonne après l’intervention chirurgicale.
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Affiliation(s)
- Eric Mbuya Musapudi
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Didier Tshibangu Mujinga
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Guy Nday Ilunga
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
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Chung PHY, Wong CWY, Ip DKM, Tam PKH, Wong KKY. Is laparoscopic surgery better than open surgery for the repair of congenital duodenal obstruction? A review of the current evidences. J Pediatr Surg 2017; 52:498-503. [PMID: 27622585 DOI: 10.1016/j.jpedsurg.2016.08.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/11/2016] [Accepted: 08/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Whether laparoscopic surgery is superior to open surgery in the repair of congenital duodenal obstruction remains controversial. The objective of this study is to systematically review the literatures, which compare the outcomes of these two operative approaches. METHODS A systematic review of the studies comparing these two surgical approaches since 2000 was carried out. RESULTS Four retrospective cohort studies comprising 180 patients were eligible for analysis. Duodenal atresia was the most common diagnosis (62.3%). Overall, there were no statistically significant differences in terms of operative duration (SMD: 0.75, 95% CI: 0.46-1.04), ventilator dependence (SMD: 0.04, 95% CI: -0.22 to 0.29), time to initial enteral feeding (SMD: 0.12, 95% CI: -0.14 to 0.38), time to full enteral feeding (SMD: 0.18, 95% CI: -0.15 to 0.50) and hospital stay (SMD: -0.03, 95% CI: -0.29 to 0.22). The overall incidences of anastomotic complications in laparoscopic vs open groups were 4.4% vs 1.8%. Two cases of missed distal pathology were reported in the laparoscopic group. CONCLUSIONS Laparoscopic surgery is feasible in the repair of CDO. Study with larger sample size is needed for further analysis to examine whether open or laparoscopic approach is superior. Meanwhile, it is still safe to practice laparoscopic repair of CDO in skilled surgeons, with attention to the possibility of distal pathology.
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Affiliation(s)
- Patrick Ho Yu Chung
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Carol Wing Yan Wong
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Dennis Kai Ming Ip
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Paul Kwong Hang Tam
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Kenneth Kak Yuen Wong
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong.
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Kumar P, Kumar C, Pandey PR, Sarin YK. Congenital Duodenal Obstruction in Neonates: Over 13 Years' Experience from a Single Centre. J Neonatal Surg 2016; 5:50. [PMID: 27896158 PMCID: PMC5117273 DOI: 10.21699/jns.v5i4.461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/03/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To study the prevalence of associated anomalies with neonatal duodenal obstruction and factors impacting short-term survival. MATERIAL AND METHODS Records of 31 neonates with neonatal duodenal obstruction could be retrieved and analyzed for a 13.5-year-period (October 2003-May 2016). M:F ratio was 1.58:1. The mean birth weight was 2.15 kg; 12 patients were preterm. Etiologies included duodenal atresia (n=23), duodenal web (n=8) and malrotation of gut (n= 6). RESULTS Associated anomalies were seen in 19/31: Down's syndrome (n=6), anorectal malformation (ARM) (n=5), annular pancreas (n=5), cardiac anomalies (n=4), esophageal atresia with trachea-esophageal fistula (EA with TEF) (n=3). Mortality in the series was 22.5%; 5 deaths and 2 patients left against medical advice in moribund state (hidden mortality). Mortality in associated anomalies group was 5/19; and 2/12 in the no anomalies group, though this difference was not statistically significant (p=0.676). Similarly, low birth weight (LBW) did not have impact on survival (p=0.639) but preterm status had highly significant p value (<0.001). CONCLUSION Duodenal atresia was the commonest cause of neonatal duodenal obstruction. Associated anomalies were noted in 61% patients, Down's syndrome being the most frequent. These anomalies did not have any significant impact on the survival, nor did LBW. Preterm status had significant impact on prognosis.
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Affiliation(s)
- Parveen Kumar
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Chiranjiv Kumar
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Prince Raj Pandey
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Yogesh Kumar Sarin
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Kim JY, You JY, Chang KHJ, Choi SJ, Oh SY, Seo JM, Roh CR, Kim JH. Association Between Prenatal Sonographic Findings of Duodenal Obstruction and Adverse Outcomes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1931-1938. [PMID: 27466262 DOI: 10.7863/ultra.15.09074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/23/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the association of prenatal sonographic findings with adverse outcomes and the causes of duodenal obstruction. METHODS A total of 59 cases of congenital duodenal obstruction were included in this study. The sonographic findings, including the degree of duodenal dilatation, polyhydramnios, and their change over gestation, were investigated. Adverse outcomes were defined as fetal death in utero, postnatal death, and gastrointestinal complications requiring readmission or reoperation during the follow-up period. The cause of duodenal obstruction was also assessed. RESULTS Among the patients studied, 2 (3.4%) had fetal death in utero and 2 (3.5%) had postnatal death. Gastrointestinal complications requiring readmission or reoperation occurred in 10.9%. In the cases with or without adverse outcomes, no significant differences were observed in the prenatal sonographic findings: maximum duodenal dilatation, mean amniotic fluid index, and the changes in these parameters with advancing gestation. The cases with adverse outcomes were associated with a younger gestational age at delivery compared to the cases without adverse outcomes. Notably, the degree of duodenal dilatation and amniotic fluid volume were greater in duodenal atresia than in other causes of obstruction, including duodenal stenosis, a duodenal web, and an annular pancreas. In the study population, the overall postoperative survival rate was 98.2%. CONCLUSIONS Prenatal sonographic findings of duodenal obstruction were not associated with adverse outcomes; however, they may be helpful for differentiating the cause of duodenal obstruction.
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Affiliation(s)
- Ji Ye Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Korea
| | - Ji Yeon You
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Korea
| | - Kylie Hae-Jin Chang
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Korea
| | - Jeong-Meen Seo
- Department of Surgery, Division of Pediatric Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Korea
| | - Jong-Hwa Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Korea
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Gale HI, Gee MS, Westra SJ, Nimkin K. Abdominal ultrasonography of the pediatric gastrointestinal tract. World J Radiol 2016; 8:656-667. [PMID: 27551336 PMCID: PMC4965350 DOI: 10.4329/wjr.v8.i7.656] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/11/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.
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Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE. Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants:: A Critically Appraised Topic. Acad Radiol 2016; 23:559-68. [PMID: 26857524 DOI: 10.1016/j.acra.2015.12.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 12/09/2015] [Accepted: 12/27/2015] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of upper and lower gastrointestinal (GI) tract obstruction in neonates and infants. METHODS A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome method comparing radiography, upper GI contrast study, and ultrasound in the detection of upper GI tract obstruction such as duodenal atresia and stenosis, jejunal and ileal atresia, and malrotation and volvulus. The same methods were used to compare radiography and contrast enema in the detection of lower GI tract obstruction such as meconium plug syndrome, meconium ileus, Hirschsprung disease, and imperforate anus. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies. RESULTS There were no sensitivities/specificities available for the imaging diagnosis of duodenal atresia or stenosis, jejunal or ileal atresias, meconium plug, and meconium ileus or for the use of cross-table lateral radiography for the diagnosis of rectal pouch distance from skin in imperforate anus. The retrieved sensitivity for the detection of malrotation on upper GI contrast study is 96%, and the sensitivity for the diagnosis of midgut volvulus on upper GI contrast study is 79%. The retrieved sensitivity and specificity for the detection of malrotation with volvulus on ultrasound were 89% and 92%, respectively. The retrieved sensitivity and specificity for the detection of Hirschsprung disease on contrast enema were 70% and 83%, respectively. The retrieved sensitivity of invertogram for the diagnosis of rectal pouch distance from skin in imperforate anus is 27%. The retrieved sensitivities of perineal ultrasound and colostography for the diagnosis of rectal pouch distance from skin in imperforate anus were 86% and 100%, respectively. CONCLUSIONS There is limited evidence for the imaging diagnosis of duodenal atresia and stenosis, jejunal and ileal atresias, meconium plug, meconium ileus, and imperforate anus, with recommended practice based mainly on low-quality evidence or expert opinion. The available evidence supports the use of upper GI contrast study for the diagnosis of malrotation and volvulus, with ultrasound as an adjunct to diagnosis. Contrast enema is useful in the investigation of suspected Hirschsprung disease, but a negative study does not outrule the condition. Colostography is the investigation of choice for the work-up of infants with complex anorectal malformations before definitive surgical repair.
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Affiliation(s)
- A G Carroll
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland.
| | - R G Kavanagh
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - C Ni Leidhin
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - N M Cullinan
- Department of Pediatrics, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - L P Lavelle
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - D E Malone
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
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