Congenital duodenal diaphragm in eight children

Abstract

Background: Congenital duodenal obstruction (CDO) is a common and usually easy to diagnose cause of intestinal obstruction in the newborn, except when the cause of the obstruction is a duodenal diaphragm. We describe our experience with eight children who had intrinsic duodenal obstruction secondary to a duodenal diaphragm.

Methods: The medical records of 22 children with the diagnosis of congenital intrinsic duodenal obstruction were reviewed for age at diagnosis, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment and outcome. Operative findings and procedures were obtained from the operative notes.

Results: Eight of the 22 children (36.4%) had congenital duodenal diaphragm (CDD). In all children, the diagnosis was made from plain abdominal X-ray, which showed the classic double-bubble appearance, and barium meal, which showed duodenal obstruction. Four patients had associated anomalies, including two with Down's syndrome. Intraoperatively, five patients were found to have duodenal diaphragm with a central hole, while the other three had complete duodenal diaphragms. Postoperatively, all patients did well. Six required total parenteral nutrition.

Conclusions: The 100% survival rate among these children is comparable to that in Western countries, and can be attributed to the lack of major associated abnormalities, good perioperative management, and the availability of total parenteral nutrition.

Figure 1

Upper gastrointestinal study showing duodenal obstruction secondary to a complete duodenal diaphragm.

Figure 2

Upper gastrointestinal study showing incomplete duodenal obstruction with contrast material passing distally through a central hole in a duodenal diaphragm.

Figure 3

Upper gastrointestinal study showing a dilated duodenum that is incompletely obstructed, with contrast material passing distally through a central hole in a duodenal diaphragm.

Figure 4

Operative photograph of the date seeds that caused obstruction of an aperture in a duodenal diaphragm in a 3-1/2-year-old girl with Down’s syndrome.