Value Of High Frequency Ultrasound In The Diagnosis Of Duodenal Obstruction In Neonates

Background and objectiveCongenital duodenal obstruction, which is caused by abnormal embryonic development, is a common digestive tract abnormality in neonates. It is also part of the congenital malformation syndrome in children. The main etiologies of congenital duodenal obstruction include duodenal atresia or stenosis, annular pancreas and intestinal malrotation and some other diseases, such as duodenal duplication, duodenal vein front door. Congenital duodenal obstruction is a great threat for the children's growth and development, so ascertaining the site and the causes of the obstruction as soon as possible is very important for the choice of surgical time, surgical procedures and prognosis.In the past, it was difficult to preoperatively find the etiology and site of obstruction clearly because of inspection equipment and technology and other reasons. Although as early as 18th century, diseases such as duodenal atresia, stenosis and annular pancreas had been recognized, there were still rare cases of successful treatment in high congenital intestinal obstruction in the 20th century. With the increase of the preoperative diagnosis rate, the improvement of the modern surgical techniques and care facilities, the cure rate of this disease has been improved greatly. Now the survival rate of congenital intestinal obstruction has been exceeded 95%. At present, the imaging modalities assessing duodenal obstruction in neonates include abdominal plain film, gastrointestinal imaging, barium enema, CT, ultrasonography and so on. The "double bubble" can be used to diagnose duodenal obstruction on X-ray, and the size of the duodenal or gastric bubble can directly reflect the severity of obstruction. However, the positive of abdominal plain film rate was not high because of the gastrointestinal decompression in children with severe vomiting. Compared with upper gastrointestinal contrast, CT examination is limited in judging a serious obstruction due to the slow movement of contrast agent. Gastrointestinal imaging and barium enema have some other disadvantages. The advantages of ultrasound are fast, accurate, non-invasive, rapid diagnosis, no special preparation, and avoiding the radiation and bariuming adverse effects caused by retention. It also can be dynamically observed the intestinal motility and blood vessels'form. This study was to evaluate the clinical significance of high frequency ultrasound in the diagnosis of duodenal obstruction in neonates.Materials and methods1. Patients dataA retrospective study was performed in 113 patients from January 2003 to August 2010, the age of the 113 neonates(81 male and 32 female) ranged from 1 day to 31 days. All children presented with persistent bilious vomiting after birth. Fifteen cases were diagnosed as duodenal obstruction before birth. All children needed to be filled with some water or milk before ultrasound examination.2. Ultrasound scanningAll examinations were performed using the Phillips IU22 and Phillips 5000 ultrasound system with 8-to 12-MHz linear transducer. The scanning started from the beginning cardia, along the gastric fundus, gastric body, pylorus, duodenum, jejunum, ileum, colon followed by scanning. The scanning focused on the entire stomach and duodenum.Results1. One hundred and six of 113 cases were diagnosed as neonatal duodenal obstruction with high-frequency ultrasound.2. The sonographic feature of the duodenal obstruction was similar on the two-dimensional imaging: the stomach was filled, the pyloric was ongoing liberalized, the duodenum was expanded with fluid and squirmed reversely at the proximal end, and the bowel at the distal end was deflated.3. Various parts of obstruction showed different duodenum expansion of coverage; Varying time and degrees of obstruction displayed different degrees of duodenal fluid expansion.4. The location of obstruction diagnosed with ultrasound was coincident with operation in 92 cases.5. The sonographic features had their own special ultrasound images for different causes of duodenal obstruction.ConclusionsThe sonographic features of various duodenal obstructions were different. Ascertaining the obstruction and causes before undertaking surgery was important for the choice of the surgery time, surgical approach and the prognosis. High frequency ultrasound played an important role in diagnosing the causes and locations of duodenal obstruction. It could be used as the primary examinations of the imaging modalities assessing duodenal obstruction in neonates.