Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India.
Department of Paediatric Surgery, St. George's University Hospital, London, England.
Afr J Paediatr Surg. 2023 Apr-Jun;20(2):97-101. doi: 10.4103/ajps.ajps_66_21.
The most common type of duodenal atresia (DA) (Type I), also known as duodenal web or membrane can present later in infancy or early childhood if the membrane or web is fenestrated. We describe six patients with delayed presentation of DA.
Retrospective review of hospital records of six patients with delayed presentation of DA due to fenestrated web managed in Paediatric Surgery Department at a tertiary care institute over a period of 2 years (January 2019 to December 2020) was done. The data of these patients were analysed on the basis of age at presentation, clinical presentation, associated anomalies, radiological findings, intra-operative findings, management and postoperative course.
The median age at presentation was 6.5 months (range: 1 month to 10 years). There were four males and two females. The most common presentation was emesis seen in all six patients. Two patients had Down syndrome. Associated congenital anomalies were cardiac in one patient, anterior ectopic anus in one patient and malrotation of midgut in one patient. Upper gastrointestinal contrast suggested incomplete duodenal obstruction in all patients. At laparotomy, fenestrated duodenal membrane was observed in all patients - preampullary in three patients and postampullary in three patients. Lateral duodenotomy, web excision and transverse closure was done in all six patients. The postoperative period was uneventful in all patients and mean duration of hospital stay was 9 days.
Fenestrated duodenal webs present a diagnostic challenge to the paediatric surgeons because of delayed and variable clinical presentation. A modification of the present classification of DA has been proposed in this study which would help in better reporting of epidemiology and aid in early diagnosis of this congenital anomaly.
最常见的十二指肠闭锁（DA）类型（I 型），也称为十二指肠隔膜或膜，如果隔膜或膜有孔，也可能在婴儿期或幼儿期后期出现。我们描述了 6 例因孔状隔膜导致延迟出现 DA 的患者。
对 2019 年 1 月至 2020 年 12 月期间在一家三级护理机构小儿外科部门接受治疗的 6 例因孔状隔膜导致延迟出现 DA 的患者的医院记录进行回顾性审查。根据就诊时的年龄、临床表现、相关异常、放射学发现、术中发现、治疗和术后过程对这些患者的数据进行分析。
就诊时的中位年龄为 6.5 个月（范围：1 个月至 10 岁）。男性 4 例，女性 2 例。最常见的表现是 6 例患者均出现呕吐。2 例患者患有唐氏综合征。1 例患者存在心脏相关畸形，1 例患者存在前肛异位，1 例患者存在中肠旋转不良。所有患者的上消化道造影均提示不完全性十二指肠梗阻。在剖腹术中，所有患者均观察到有孔的十二指肠隔膜-3 例位于壶腹前，3 例位于壶腹后。所有 6 例患者均行侧十二指肠切开术、隔膜切除和横断缝合。所有患者术后均无并发症，平均住院时间为 9 天。
由于临床表现延迟且多变，孔状十二指肠隔膜给小儿外科医生带来了诊断挑战。本研究提出了一种对 DA 分类的改进，这将有助于更好地报告流行病学，并有助于早期诊断这种先天性异常。
