Beruflich Dokumente
Kultur Dokumente
Duodenal Atresia
Epidemiology
• 1 per 5000 to 10,000 live births
• Affecting boys more commonly than girls
• More than 50% of affected patients have associated congenital
Etiology
• Congenital duodenal obstruction
• Intrinsic or extrinsic gastrointestinal lesion
Intrinsic lesion caused by a failure of recanalization of the
fetal duodenum
Extrinsic form defects in the development of neighboring
structures
Diagnosis
• History of polyhydramnios
• Prenatal ultrasonography detect two fluid-filled structures
consistent with a double bubble in up to 44% of cases
• Most cases of duodenal atresia are detected at between 7 and
8 months of gestation
• The diagnostic radiographic presentation (upright abdominal
radiograph) “double bubble” sign with no distal bowel gas
Pre-operative care
• Appropriate resuscitation
• Correction of fluid balance and electrolyte abnormalities
• Perenteral nutrition via central catheter line
THERAPY / OPERATION
• Surgical correction of duodenal obstruction is not urgent
• Various techniques:
Side-to-side duodenoduodenostomy,
Diamond-shaped duodenoduodenostomy,
Partial web resection with heineke-mikulicz–type duodenoplasty,
Tapering duodenoplasty
• Today, the procedure of choice is either laparoscopic or open
duodenoduodenostomy
• Long side-to-side duodenoduodenostomy, although effective, is
associated with a high incidence of anastomotic dysfunction and
prolonged obstruction
• Duodenojejunostomy blind-loop syndrome appears to be more
common
• Gastrojejunostomy high incidence of marginal ulceration and
bleeding
• Or the open approach right upper quadrant supraumbilical
transverse incision is made
• After mobilizing the ascending and transverse colons to the left, the
duodenal obstruction is readily exposed
POST-OPERATIVE CARE
• Total parenteral nutrition (tpn) is continued
• Feedings may be started when the volume of the nasogastric
output has
• Diminished and its color has lightened and it becomes clear
several days to a week
• Small feedings are then initiated with volume and
concentration advanced as tolerated
• The majority may be discharged within one to several weeks
Complications
Intraoperative
• Incorrect identification of the site of obstruction most
commonly occurs when a long, floppy web (windsock deformity)
is present
• More than one obstruction present (rare)
• Postoperative
The most common prolonged feeding intolerance
In general, if no specific difficulties were encountered at the
initial procedure, there should be concern if relatively normal
function has not been achieved by 3 weeks