eMedicine Specialties > Pediatrics: Surgery > General Surgery

Duodenal Atresia and Stenosis: Surgical Perspective: Follow-up

Author: Nicola Lewis, MBBS, FRCS, Specialist Registrar, Department of Surgery, Birmingham Children's Hospital, UK
Coauthor(s): Philip Glick, MD, MBA, Professor, Departments of Surgery, Pediatrics, and Gynecology and Obstetrics, Vice-Chairperson for Research and Development, Department of Surgery, State University of New York at Buffalo
Contributor Information and Disclosures

Updated: Oct 1, 2008

Outcome and Prognosis

Current survival rates for infants with duodenal atresia or stenosis are 90-95%. Higher mortality rates are associated with prematurity and multiple congenital abnormalities.

Postoperative complications are reported in 14-18% of patients; some require reoperation.2 Possible indications for reoperation include anastomotic leak, functional duodenal obstruction, adhesions, and missed atresias.

Long-term follow-up of these patients reveals that most of these patients are asymptomatic with a normal nutritional status. In a 1988 study, Kokkonen et al found a poor correlation between symptoms and radiologic and endoscopic findings; the megaduodenum failed to return to normal caliber, and duodenogastric reflux and duodenal dysmotility persisted decades after the initial surgery in asymptomatic patients.21 Approximately 12% of patients develop late complications. Late deaths occur in approximately 6% of patients, and 50% of these are related to complex cardiac conditions. Less than 10% of patients require fundoplication for gastroesophageal reflux, and less than 10% require revision of the initial repair.23

Dysmotility disorders associated with megaduodenum can be managed with an antimesenteric tapering duodenoplasty or duodenal plication.

Future and Controversies

Duodenal webs can be diagnosed and excised by an expert surgical endoscopist. This is feasible in patients who present after the neonatal period with duodenal stenosis. The morbidity and complications associated with a megaduodenum may require further surgical intervention.

Transanastomotic feeding tubes or gastrostomies were used in the past but have been demonstrated to offer no clear advantage and, instead, result in a delay in establishing oral feedings and an increase in the duration of hospitalization.24,3,25

 


More on Duodenal Atresia and Stenosis: Surgical Perspective

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Workup: Duodenal Atresia and Stenosis: Surgical Perspective
Treatment: Duodenal Atresia and Stenosis: Surgical Perspective
Follow-up: Duodenal Atresia and Stenosis: Surgical Perspective
Multimedia: Duodenal Atresia and Stenosis: Surgical Perspective
References
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References

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  2. Bailey PV, Tracy TF Jr, Connors RH, et al. Congenital duodenal obstruction: a 32-year review. J Pediatr Surg. Jan 1993;28(1):92-5. [Medline].

  3. Mooney D, Lewis JE, Connors RH, Weber TR. Newborn duodenal atresia: an improving outlook. Am J Surg. Apr 1987;153(4):347-9. [Medline].

  4. Kimura K, Mukohara N, Nishijima E, et al. Diamond-shaped anastomosis for duodenal atresia: an experience with 44 patients over 15 years. J Pediatr Surg. Sep 1990;25(9):977-9. [Medline].

  5. Mishalany HG, Der Kaloustian VM, Ghandour MH. Familial congenital duodenal atresia. Pediatrics. Mar 1971;47(3):633-4. [Medline].

  6. Boyden EA, Cope JG, Bill AH Jr. Anatomy and embryology of congenital intrinsic obstruction of the duodenum. Am J Surg. Aug 1967;114(2):190-202. [Medline].

  7. Grosfeld JL, Rescorla FJ. Duodenal atresia and stenosis: reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long-term follow-up. World J Surg. May-Jun 1993;17(3):301-9. [Medline].

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  25. Upadhyay V, Sakalkale R, Parashar K, et al. Duodenal atresia: a comparision of three modes of treatment. European Journal of Pediatric Surgery. 1996;6(2):75-77. [Medline].

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  27. Cragan JD, Martin ML, Moore CA, Khoury M. Descriptive epidemiology of small intestinal atresia, Atlanta, Georgia. Teratology. Nov 1993;48(5):441-50. [Medline].

  28. Takahashi A, Tomomasa T, Suzuki N, et al. The relationship between disturbed transit and dilated bowel, and manometric findings of dilated bowel in patients with duodenal atresia and stenosis. J Pediatr Surg. Aug 1997;32(8):1157-60. [Medline].

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Further Reading

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Keywords

duodenal atresia, stenosis, congenital duodenal obstruction, gastrojejunostomy, duodenojejunostomy, duodenoduodenostomy, duodenoplasty, intrinsic duodenal obstruction, high intestinal obstruction, upper intestinal obstruction, sustained vomiting, bilious vomiting, nonbilious vomiting, loss of fluid, loss of electrolytes, hyperalimentation, Down syndrome, esophageal atresia, malrotation, anterior portal vein, second distal web, anorectal anomalies, intestinal atresias, cloacal anomalies, renal tract anomalies, polyhydramnios, choledochal cyst, failure to thrive

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Contributor Information and Disclosures

Author

Nicola Lewis, MBBS, FRCS, Specialist Registrar, Department of Surgery, Birmingham Children's Hospital, UK
Disclosure: Nothing to disclose.

Coauthor(s)

Philip Glick, MD, MBA, Professor, Departments of Surgery, Pediatrics, and Gynecology and Obstetrics, Vice-Chairperson for Research and Development, Department of Surgery, State University of New York at Buffalo
Philip Glick, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, Central Surgical Association, Federation of American Societies for Experimental Biology, Medical Society of the State of New York, Phi Beta Kappa, Physicians for Social Responsibility, Royal College of Surgeons of England, Sigma Xi, Society for Pediatric Research, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, and Society of University Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Robert K Minkes, MD, PhD, Professor of Surgery, University of Texas Southwestern; Chief of Surgical Services, Children's Medical Center of Dallas-Legacy
Robert K Minkes, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Andre Hebra, MD, Chief, Division of Pediatric Surgery, Medical University of South Carolina; Professor of Surgery and Pediatrics, Medical University of South Carolina
Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Association for Academic Surgery, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

H Biemann Othersen Jr, MD, Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina
H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Marleta Reynolds, MD, Professor of Surgery, Feinberg School of Medicine, Northwestern University; Interim Head, Division of Pediatric Surgery, Department of Surgery, Children's Memorial Hospital of Chicago
Marleta Reynolds, MD is a member of the following medical societies: American Pediatric Surgical Association
Disclosure: Nothing to disclose.

 
 
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