Duodenal atresia surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
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Overview
Surgery is the mainstay of treatment for duodenal atresia. A nasogastric or orogastric tube should be inserted to decompress the abdomen. A laparotomy or laparoscopy can be performed to correct duodenal atresia. Surgical procedures for the correction of duodenal atresia include duodenoduodenostomy and duodenojejunostomy.
Indications
Surgery is the first-line treatment option for patients with duodenal atresia. If the case is confirmed by: [1]
- Ultrasound: shows duodenal obstruction
- Abdominal x-ray: shows air fluid levels
Surgery
Surgery is the mainstay of treatment for duodenal atresia.[1][2][3]
- Laparotomy or laparoscopy can be performed.
- A nasogastric or orogastric tube should be inserted to decompress the abdomen.
Surgical procedures include:
- Side-to-side duodenoduodenostomy
- Bypass procedure
- Diamond-shaped anastomosis is constructed between the proximal transverse to the distal longitudinal anastomosis
- End-to-side duodenoduodenostomy
- Bypass procedure
- Diamond-shaped anastomosis is constructed between the proximal transverse to the distal longitudinal anastomosis
- Duodenojejunostomy
Post Operative Care
- Orogastric tube is left in place for drainage
- Oral feedings not given until
- Give total parenteral nutrition (TPN)
Preparation for surgery
- Orogastric decompression of the stomach
- Fluid resuscitation
- Broad-spectrum antibiotics
- 1 mg vitamin K
Post Surgical Complications
The post surgical complications of duodenal atresia are as follows:[4][5][6]
- Post surgical complications include:
- Adhesions
- Blind loop syndrome
- Duodenal dysmotility
- Megaduodenum
- Duodenogastric reflux and gastritis
- Peptic ulcer disease
- Gastroesophageal reflux
- Cholelithiasis
- Cholecystitis
Contraindications
There are no contraindications to surgical repair of duodenal atresia.
References
- ↑ 1.0 1.1 Freeman, SB; Torfs, CP; Romitti, PA; Royle, MH; Druschel, C; Hobbs, CA; Sherman, SL (2009). "Congenital gastrointestinal defects in Down syndrome: a report from the Atlanta and National Down Syndrome Projects". Clinical Genetics. 75 (2): 180–184. doi:10.1111/j.1399-0004.2008.01110.x. ISSN 0009-9163.
- ↑ Kay, Saundra; Yoder, Suzanne; Rothenberg, Steve (2009). "Laparoscopic duodenoduodenostomy in the neonate". Journal of Pediatric Surgery. 44 (5): 906–908. doi:10.1016/j.jpedsurg.2009.01.025. ISSN 0022-3468.
- ↑ Morris, Grant; Kennedy, Alfred; Cochran, William (2016). "Small Bowel Congenital Anomalies: a Review and Update". Current Gastroenterology Reports. 18 (4). doi:10.1007/s11894-016-0490-4. ISSN 1522-8037.
- ↑ Spigland N, Yazbeck S (1990). "Complications associated with surgical treatment of congenital intrinsic duodenal obstruction". J Pediatr Surg. 25 (11): 1127–30. PMID 2273425.
- ↑ Kokkonen ML, Kalima T, Jääskeläinen J, Louhimo I (1988). "Duodenal atresia: late follow-up". J Pediatr Surg. 23 (3): 216–20. PMID 3357136.
- ↑ Bishay, M.; Lakshminarayanan, B.; Arnaud, A.; Garriboli, M.; Cross, K. M.; Curry, J. I.; Drake, D.; Kiely, E. M.; De Coppi, P.; Pierro, A.; Eaton, S. (2012). "The role of parenteral nutrition following surgery for duodenal atresia or stenosis". Pediatric Surgery International. 29 (2): 191–195. doi:10.1007/s00383-012-3200-9. ISSN 0179-0358.