Retrospective Analysis Of 57 Cases Of Congenital Duodenal Obstruction

Objective:To summarize the clinical data of congenital duodenal obstruction,in order to improve the understanding of the clinical characteristics and the main points of diagnosis and treatment of the common pathological types of congenital duodenal obstruction,improve the recovery of children and accelerate their postoperative recovery.Methods:Retrospective analysis was performed on 57 cases of congenital duodenal obstruction diagnosed during the period from January 1,2007 to November 30,2019 in the department of neonatal general surgery,Changchun children’s hospital.This paper summarized the clinical characteristics of congenital duodenal obstruction in different age groups and pathological types,prenatal examination data,imaging examination,surgical methods and prognosis,and analyzed and discussed the above clinical case data.Results:A total of 57 children with congenital duodenal obstruction were included in the study,among which 34 were males,23 were females,and 2 were given up treatment.They were divided into 2 groups according to age stage,newborn group(≤28 days): 36 cases in total,and non-newborn group: 21 cases.According to the pathological type,the patients were divided into 3 groups,including 33 cases of congenital intestinal malrotation,17 cases of duodenal atresia or stricture and 7 cases of annular pancreas.(2)most of the clinical symptoms were vomiting.The proportions of annular pancreas,duodenal diaphragm stenosis or atresia and congenital intestinal malrotation with vomiting as the first symptom were 17.03%(7/41),29.27%(12/41)and 53.67%(22/41),respectively.In addition to vomiting,some children suffered from other diseases,including 12 cases with pneumonia,accounting for 29.27%.There were 5 cases with electrolyte disturbance,accounting for12.20%.There were 7 cases with jaundice,accounting for 17.07%.The detection rate of duodenal obstruction in prenatal ultrasound was 77.78%(21/27).The positive rates were39.40%(13/33),41.18%(7/17)and 28.58%(2/7)in the preoperative diagnosis of annular pancreas and duodenal diaphragm stricture or atresia and congenital intestinal malrotation.The positive rates were 42.86%(3/7),88.24%(15/17),and 69.70%(23/33),respectively,for the preoperative diagnosis of annular pancreas,duodenal septum stricture or atremia and congenital intestinal malrotation.The positive rates of preoperative diagnosis of annular pancreas,duodenal septum stricture or atresia and congenital intestinal malrotation were 57.14%(4/7),47.06%(8/17)and 60.61%(20/33),respectively.In 57 cases,33 patients with congenital malrotation of the intestine underwent Ladd’s;Duodenal atresia or stricture was performed with 17 procedures including duodenoplasty and duodenal septum resection.The annular pancreas underwent 7 side duodenal anastomosis and duodenal lozenge anastomosis.(5)the children in this group recovered well after surgery,and the mean postoperative recovery time and hospitalization time were 6.88 d and16.33 d.The factors affecting postoperative recovery include surgical method,combined operation and body weight.Conclusion: 1.In congenital duodenal obstruction,the incidence rate of male is high.2.Prenatal Doppler ultrasonography is an effective method to find duodenal obstruction.Upper gastrointestinal radiography is the first choice to diagnose congenital duodenal obstruction before operation.Abdominal X-ray film and Doppler ultrasonography are of great significance for the diagnosis of congenital duodenal obstruction.3.Early detection,early treatment,reduction of preoperative complications,and selection of reasonable surgical methods can improve the recovery and accelerate the postoperative rehabilitation of children.