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Kudo H, Kazama T, Fukuzawa T, Ando R, Okubo R, Sakurai T, Hashimoto M, Endo Y, Nio M, Wada M. Utility of the web excision with pre-membranous incision for congenital intestinal atresia-type I and stenosis. BMC Pediatr 2024; 24:454. [PMID: 39009961 PMCID: PMC11247809 DOI: 10.1186/s12887-024-04925-6] [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: 03/30/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024] Open
Abstract
PURPOSE This study analyzed the efficacy of web excision combined with a pre-membranous incision on the dilated proximal segment for congenital intestinal atresia with type I and stenosis (CIA-I/S). PATIENTS AND METHODS Twenty-six patients underwent surgery for CIA-I/S from January 1990 to June 2022. Patients were categorized into 3 groups according to the surgical procedure: Group A, web excision with pre-membranous incision of the dilated intestine (n = 14); Group B, enteroplasty with a trans-membranous vertical incision (n = 7) and Group C, diamond-shaped anastomosis (n = 5). To minimize the impact of obstruction location on outcomes, we specifically examined 17 cases of duodenal atresia/stenosis: Group D-A, (n = 6); Group D-B, (n = 6) and Group D-C, (n = 5). We retrospectively compared the operative and postoperative parameters among the three groups. RESULTS No patient experienced anastomotic leakage or obstruction. There were no significant differences in operative duration or blood loss among the 3 Groups. The median time to feeding initiation was 4, 6.5, and 5 days in Groups A, B, and C, respectively (p = 0.04) and was 4, 6.5, and 5 days in Groups D-A, D-B, and D-C, respectively (p = 0.04). CONCLUSION Web excision, when compared to enteroplasty and diamond-shaped anastomosis, showed comparable results in terms of the operative duration and postoperative complications. However, it may allow for an earlier initiation of enteral nutrition.
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Affiliation(s)
- Hironori Kudo
- Departments of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Takuro Kazama
- Departments of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Taichi Fukuzawa
- Departments of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Ryo Ando
- Departments of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Ryuji Okubo
- Departments of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Tsuyoshi Sakurai
- Departments of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Masatoshi Hashimoto
- Departments of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Yuki Endo
- Departments of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Masaki Nio
- Departments of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Motoshi Wada
- Departments of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan.
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Kasimi A, Nasri S, Haddar L, Samet M, Azzouzi DE, Babakhouya A, Aichouni N, Kamaoui I, Skiker I. Delayed presentation of duodenal diaphragm and annular pancreas in a 10-year-old girl: Case report. Radiol Case Rep 2024; 19:264-267. [PMID: 38028306 PMCID: PMC10654427 DOI: 10.1016/j.radcr.2023.10.003] [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: 02/14/2023] [Revised: 09/05/2023] [Accepted: 10/01/2023] [Indexed: 12/01/2023] Open
Abstract
Congenital duodenal obstruction is a common cause of bowel obstruction. It is relatively easy to diagnose in the neonatal period. However, if the obstruction is due to a duodenal diaphragm, diagnosis may be delayed until later in infancy or even adulthood, depending on the size of the aperture in the diaphragm. Congenital duodenal obstruction may be associated with other gastrointestinal and biliary anomalies. The association of a duodenal diaphragm and a partial annular pancreas is a rare clinical entity. We present an unusual case of late presentation of duodenal diaphragm with partial annular pancreas in a 10-year-old girl with a 3-month history of abdominal distension and vomiting. The plain abdominal X-ray showed the classic picture of a double bubble. The CT images showed narrowing of the third duodenal portion and dilatation of the stomach and duodenum. The pancreatic tissue incompletely surrounded the second part of the duodenum. Intraoperatively, both the duodenal diaphragm and the partial annular pancreas were confirmed. Excision of the diaphragm and duodenoplasty were performed. A duodenal diaphragm should be suspected in patients with a history of abdominal distension and vomiting, even in late childhood. Associated gastrointestinal and biliary anomalies should always be excluded.
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Affiliation(s)
- Asmae Kasimi
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Siham Nasri
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Leila Haddar
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Mahdi Samet
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Driss El Azzouzi
- Department of Pediatric Surgery, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Abdeladim Babakhouya
- Department of Pediatrics, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Narjisse Aichouni
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Imane Kamaoui
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Imane Skiker
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
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Ekram K, Razawi F, Jalal SN, Sultani MN, Wali AW, Sediqi MS, Hamdard AG, Hemat M, Sahibzada MM. Congenital duodenal web causing partial obstruction with recurrent vomiting and abdominal distention in a toddler boy: a case report. J Med Case Rep 2023; 17:507. [PMID: 37996900 PMCID: PMC10668464 DOI: 10.1186/s13256-023-04179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/14/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The duodenal web is a thin, elongated, web-like structure that is one of the factors contributing to duodenal obstruction. Only 100 cases have been reported in the literature. We present a 2.5-year-old cachectic Afghan child who did not have any overt signs and symptoms of intestinal obstruction, like recurrent vomiting, abdominal distention, and weight loss. The web was discovered near the intersection of the third and fourth portions, which is an uncommon location for the duodenal web. The late presentation of congenital duodenal web with partial obstruction is rare but well-known and has been reported in this case. CASE PRESENTATION A 2.5-year-old cachectic Afghan child who had recurrent vomiting and experienced abdominal distention was brought to Maiwand Teaching Hospital from the Jabelsuraj region of Parwan province. The patient was suffering from unusual signs and symptoms like recurrent vomiting, abdominal distention, weight loss, and constipation. The diagnosis of these anomalies was established by a detailed history, clinical features, and abdominal CT scan. In the computerized tomography scanning (CT-Scan) image reported, there was a web with stenosis and partial obstruction in the distal aspect of the third-to-fourth portion of the duodenum. After preoperative stabilization, the child was taken for surgery. The abdomen was opened by a right upper abdominal transverse incision. After web resection and duodenoplasty, the patient was shifted to the recovery room in satisfactory condition. The child was allowed to feed after 8 days, which he tolerated well. CONCLUSION Congenital duodenal web with partial obstruction is typically observed in the second and third years of life. It is suspected in patients with recurrent vomiting, abdominal distention, weight loss, and constipation. Partial obstruction may not have an overt presentation, making it a challenging diagnosis for general practitioners. Abdomen X-ray and CT scan usually confirm the diagnosis, and successful surgical intervention is recommended.
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Affiliation(s)
- Khesrow Ekram
- Department of Pediatrics, Maiwand Teaching Hospital, Kabul University of Medical Sciences, 1st District, Jada-e-Maiwand, 1001, Kabul, Afghanistan.
| | - Farida Razawi
- Department of Pediatric Surgery, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Sayed Najmuddin Jalal
- Department of Pediatrics, Maiwand Teaching Hospital, Kabul University of Medical Sciences, 1st District, Jada-e-Maiwand, 1001, Kabul, Afghanistan
| | - Mohammad Nader Sultani
- Department of Pediatric Surgery, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Abdul Wali Wali
- Department of Pediatrics, Maiwand Teaching Hospital, Kabul University of Medical Sciences, 1st District, Jada-e-Maiwand, 1001, Kabul, Afghanistan
| | - Mohammad Sharif Sediqi
- Department of Pediatrics, Maiwand Teaching Hospital, Kabul University of Medical Sciences, 1st District, Jada-e-Maiwand, 1001, Kabul, Afghanistan
| | - Abdul Ghafar Hamdard
- Department of Dermatology, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Massoud Hemat
- Department of Pediatric Surgery, Kabul University of Medical Sciences, Kabul, Afghanistan
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Tiwari C, Borkar NB, Singh S, Mane S, Sinha C. Delayed presentation of duodenal atresia. Afr J Paediatr Surg 2023; 20:97-101. [PMID: 36960502 DOI: 10.4103/ajps.ajps_66_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background The most common type of duodenal atresia (DA) (Type I), also known as duodenal web or membrane can present later in infancy or early childhood if the membrane or web is fenestrated. We describe six patients with delayed presentation of DA. Materials and Methods Retrospective review of hospital records of six patients with delayed presentation of DA due to fenestrated web managed in Paediatric Surgery Department at a tertiary care institute over a period of 2 years (January 2019 to December 2020) was done. The data of these patients were analysed on the basis of age at presentation, clinical presentation, associated anomalies, radiological findings, intra-operative findings, management and postoperative course. Results The median age at presentation was 6.5 months (range: 1 month to 10 years). There were four males and two females. The most common presentation was emesis seen in all six patients. Two patients had Down syndrome. Associated congenital anomalies were cardiac in one patient, anterior ectopic anus in one patient and malrotation of midgut in one patient. Upper gastrointestinal contrast suggested incomplete duodenal obstruction in all patients. At laparotomy, fenestrated duodenal membrane was observed in all patients - preampullary in three patients and postampullary in three patients. Lateral duodenotomy, web excision and transverse closure was done in all six patients. The postoperative period was uneventful in all patients and mean duration of hospital stay was 9 days. Conclusion Fenestrated duodenal webs present a diagnostic challenge to the paediatric surgeons because of delayed and variable clinical presentation. A modification of the present classification of DA has been proposed in this study which would help in better reporting of epidemiology and aid in early diagnosis of this congenital anomaly.
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Affiliation(s)
- Charu Tiwari
- Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
| | | | - Sunita Singh
- Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
| | - Sonali Mane
- Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
| | - Chandrasen Sinha
- Department of Paediatric Surgery, St. George's University Hospital, London, England
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Abstract
INTRODUCTION Duodenal obstructions caused by congenital anatomic abnormalities are rare in adults. Several patients in whom the duodenal obstruction was caused by a congenital duodenal diaphragm have been described. The duodenal obstruction in the patient presented herein was caused by a transverse septum, which has not been previously reported. A transverse septum is usually observed in the vagina; those involving the digestive tract have been rarely observed. CASE PRESENTATION We herein report a case involving a 69-year-old woman with a congenital duodenal transverse septum causing partial obstruction. She was admitted to our hospital with a 3-month history of epigastric pain and vomiting. Upper gastrointestinal endoscopy, iodinated water-soluble contrast imaging, and abdominal computed tomography revealed dilation of the stomach and a neoplasm in the descending part of the duodenum. The patient was suspected to have a tumor in the descending part of the duodenum. Exploratory laparotomy showed a banded duodenal transverse septum at the junction of the second part of the duodenum. The duodenal transverse septum was approximately 2 mm thick and 1 cm wide and divided the duodenal lumen into 2 parts. The duodenal papillae were completely normal and located under the duodenal transverse septum. Histopathological analysis of the transverse septum showed that it was similar to the organizational structure of the duodenal wall. CONCLUSION The possibility of congenital disease should be considered in older patients with intestinal obstruction, even when imaging studies reveal a duodenal neoplasm.
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Mousavi SA, Karami H, Saneian H. Congenital duodenal obstruction with delayed presentation: seven years of experience. Arch Med Sci 2016; 12:1023-1027. [PMID: 27695493 PMCID: PMC5016578 DOI: 10.5114/aoms.2016.60045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 11/22/2014] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The duodenum is the most common site for congenital intestinal obstruction. The duodenal web with a central hole can present without any overt signs of obstruction at a later age. MATERIAL AND METHODS Over a 7-year period, children with congenital intestinal obstruction were identified in this study. The complications and operative findings of patients with duodenal web with conditions such as wind sock deformity and delayed diagnosis were evaluated in this study. RESULTS This study included 81 infants with congenital intestinal obstruction. At operation, 48 patients demonstrated duodenal obstruction with atresia in 27, annular pancreas in 15 and malrotation in 6. Also, we observed incomplete obstruction of the duodenum due to a fenestrated web in 8 patients. The age of these patients at operation time ranged from 5 days to 72 months. Fifty percent of affected patients were associated with trisomy 21, all of whom exhibited failure to thrive due to food intolerance. The patients older than 2 years presented with major complications of gastroesophageal reflux such as esophageal ulcer, stricture and dysphagia. Additionally we had a unique case of a patient who had been referred with an epigastric mass. During the operation, we found 440 seeds of various fruits in the stomach and the first portion of the duodenum. CONCLUSIONS Our study emphasizes that duodenal web with a central hole can present without signs of obstruction at a later age with only failure to thrive and food intolerance. Therefore a high index of suspicion is necessary for diagnosis when it presents beyond the usual age.
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Affiliation(s)
- Seyed Abdollah Mousavi
- Department of Pediatric Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hasan Karami
- Department of Pediatric Gastroenterology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Saneian
- Department of Pediatric Gastroenterology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Bhat NA. Congenital duodenal diaphragm and enteroliths: A Unique complication. J Indian Assoc Pediatr Surg 2011; 14:226-7. [PMID: 20419028 PMCID: PMC2858889 DOI: 10.4103/0971-9261.59609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report an unusual case of duodenal diaphragm (DD) with “wind-sock” anomaly in a 6-year-old male. The child presented with an acute duodenal obstruction precipitated by multiple pigmented stones completely blocking the duodenum.
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Affiliation(s)
- Nisar Ahmad Bhat
- Department of Paediatric Surgery, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
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Affiliation(s)
- Ahmed Hassan Al-Salem
- Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arabia.
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