Surgical Treatment for Congenital Duodenal Obstruc tion

RAVIT RUANGTRAKOOL,M.D.*, MONGKOL LAOHAPENSANG, M.D.*, AKKRAPOL MUNGNIRANDR, M.D.*, CHANA SATHORNKICH, M.D.*

Affiliation : * Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

AbstractThirty-four congenital duodenal obstructions (19 duodenal atresia, 7 duodenal web, 7 annular pancreas and one duodenal stenosis) were surgically treated in Siriraj Hospital between 1990 and 1999. Eleven per cent of duodenal atresia had no bile-stained vomiting. Duodenal web which received web excision and duodenoplasty in 43 per cent of cases, also presented with bile-stained vomiting. Duodeno-duodenostomy, duodeno-jejunostomy and web excision with duodenoplasty were performed in 29, 2 and 3 patients respectively. Duodeno-duodenostomy and web excision with duodenoplasty had no difference in the feeding capability. There was no statistically significant difference in dura tion of TPN, ability to be early fed, post-operative onset of full feeding and hospital stay between diamond-shaped (n = 18) and side-to-side (n = 11) duodeno-duodenostomy. Although transanas tomotic feeding tube (n =4) decreased a percentage of TPN requirement and made early feeding possible, the onset of full feeding, duration of TPN and hospital stay were not different from those who had no transanastomotic tube (n= 30).

Keywords : Duodenal Obstruction, Duodenal Atresia, Pancreas, Suture Techniques, Anastomosis, Postoperative Complications, Treatment Outcome, Child, Infant, Newborn

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