The incidence of neonatal duodenal obstruction has been variously estimated as 1 in 10000 to 1 in 40000 live births. Duodenum obstruction may also caused by annular pancreas and band of Ladd in association with malrotation.The detection of double bubble sign on plain radiograph of abdomen lead to suspicion of duodenal obstruction. Duodenoduodenostomy of different technique has been used to bypass duodenal obstruction.
To study congenital duodenal obstruction (atresia,annular pancreas and malrotation) and to evaluate and analyze the age presentation, x-ray findings and the operative findings in comparison with other studies, with emphases to the operative procedures suitable for each cause.
PATIENTS AND METHODS:
In this study patients were collected prospectively through the period between first of January 2010 to the end of January 2013 in pediatric surgical ward, at Al-Khansa teaching hospital in Mosul/Iraq. Erect abdominal x-ray was done for all patients to assess the radiological findings, while barium meal done selectively. Operative findings were evaluated in relation to the cause of obstruction, site, degree of proximal dilatation, presence of distal obstruction and other associated anomalies.
Surgical procedures were used according to the operative findings which were either diamond duodenoduodenostomy (DDD), side to side duodenoduodenostomy (SSDD), side to side duodenojejunostomy (SSDJ), Ladds procedure and Heinecke-Mikulicz (HM) or combined procedures.
Fifty six patients were admitted to our center, 31male (55.5%) and 25 female (44.5%). Fourty five patients presented in the first 4 days of life (80%), 35 of them (60%) in the first 2 days, while 11 patients (20%) were delayed after the seven day of life, one patient aged one month proved to have fenestrated web. Vomiting was the main presenting symptoms in 50 patients (90%), and was bile stained in 42 patients (85%) and nonbile stained in 8 patients (15%). Erect abdominal x-ray show typical double bubble gases shadow sign in 39 patients (70%), Operative findings at time of exploration shows 36 atresia(67%) including 25 web(type one atresia), type 2 atresia in 8 patients and 3 patients with type 3 artesian. annular pancreas were detected in 11 patients(20%) and 7 patients(13%) with malrotaion. Diamond duodenoduodenostomy (DDD) was the procedure of choice in 38 patients (70%).
The double bubble sign in erect abdominal X-ray is still diagnostic for cases with complete obstruction. High index of suspicious in patients with bilious vomiting is important for early referral, Diamond duodenoduodenostomy is very effective technique in most cases with very good post operative results.