Clinical characteristics and treatments of prenatally diagnosed congenital duodenal obstruction in children
Objective To summarize the postnatal clinical characteristics and treatments of fetuses with prenatally diagnosed congenital duodenal obstruction(CDO).Methods A total of 105 children with prenatally diagnosed CDO operated after birth were reviewed between January 2011 and December 2020.There were 48 boys and 57 girls with a gestational age of 15-39 weeks at an initial diagnosis,a gestational age of 31+1-42 weeks at birth and an average birth weight of 2746.9(1350-4250)gram.Among them,38 were bom prematurely.The median age of admission was 9 hours(1-21 days).Postnatal vomiting occurred with(n=14)or without(n=26)breastfeeding.There were 80 cases with other system malformations,including congenital heart disease(n=69)and 2 or more types of other malformations(n=36).All pathological types were confirmed intraoperatively.Feeding time,length of hospital stay and postoperative complications were recorded.The relevant clinical data were processed by SPSS 19.0.Results All surgical procedures were successfully performed,including laparotomy(n=23),laparoscopy(n=80)(converting into laparotomy,n=2)and robot-assisted surgery(n=2).Annular pancreas(n=78),duodenal atresia(n=15),duodenal stenosis(n=10),malrotation(n=13),preduodenal portal vein(n=2)and jejunal origin atresia(n=1)were diagnosed.Among them,14 patients had two or more obstructions.Postoperative feeding time were(7.64±3.28)days and postoperative hospitalization stay(16.66±9.12)days.Postoperative complications occurred(n=3),including anastomotic leakage(n=1)and intestinal obstruction(n=1).Both improved after conservative measures.Another case of anastomotic stenosis after distal duodenal atresia and proximal jejunal type Ⅲatresia improved after intestinal resection and anastomosis plus duodenoplasty.Conclusions Time of admission and treatment of prenatally diagnosed CDO were advanced.Fasting and gastrointestinal decompression should be performed after birth and the prognosis is excellent after early surgery.Annular pancreas is the most common pathological type.Usually accompanied by other system malformations,prenatal screening should focus on chromosomes and heart.
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