Congenital Duodenal Obstruction

Background/Purpose: Congenital duodenal obstruction is a frequent cause of intestinal obstruction in the newborn. This study aimed to analyze various factors affecting the outcome of these cases at our institution. Materials & Methods: Seventy one cases of congenital duodenal obstruction were included in this retrospective review. Each case was studied as regard to: age at presentation, gestaional age, clinical data, other associated congenital anomalies, cause of obstruction, management, and outcome. Patients with abdominal wall defects (omphalocoele, gastroschisis) and diaphragmatic hernias were excluded from the study. Results: The causes of duodenal obstruction were: duodenal atresia (n = 37), duodenal diaphragm (n = 12), malrotation (n = 14), and annular pancreas (n = 8). Age ranged from 2 days to 24 months. Bilious vomiting was the main presenting symptom. Plain radiography was the most valuable diagnostic tool in all cases except malrotation and partial obstruction. Gastrointestinal (GIT) contrast study was very valuable in that later group. Overall mortality was 15 cases (21.1 %). The causes of deaths were: prolonged gastric stasis and neonatal sepsis(n = 7), other associated cardiac anomalies (n =5), and extensive bowel gangrene due to neglected volvulus neonatorum(n = 3). Conclusion: This study showed that (1) the diagnosis of congenital duodenal obstruction is still delayed in many patients referred to our institutions.(2) early postoperative survival is still far from ideal; (3) the mortality is related to delayed presentation, associated cardiac defects, and prolonged gastric stasis; and (4) late complications are more common than previously expected