Duodenal atresia surgery: Difference between revisions

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Latest revision as of 19:44, 5 January 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Overview

Surgery is the mainstay of treatment for duodenal atresia. A nasogastric or orogastric tube should be inserted to decompress the abdomen. A laparotomy or laparoscopy can be performed to correct duodenal atresia. Surgical procedures for the correction of duodenal atresia include duodenoduodenostomy and duodenojejunostomy.

Indications

Surgery is the first-line treatment option for patients with duodenal atresia. If the case is confirmed by: ^[1]

Ultrasound: shows duodenal obstruction
Abdominal x-ray: shows air fluid levels

Surgery

Surgery is the mainstay of treatment for duodenal atresia.^[1]^[2]^[3]

Laparotomy or laparoscopy can be performed.

A nasogastric or orogastric tube should be inserted to decompress the abdomen.

Surgical procedures include:

Side-to-side duodenoduodenostomy
- Bypass procedure
- Diamond-shaped anastomosis is constructed between the proximal transverse to the distal longitudinal anastomosis
End-to-side duodenoduodenostomy
- Bypass procedure
- Diamond-shaped anastomosis is constructed between the proximal transverse to the distal longitudinal anastomosis
Duodenojejunostomy

Post Operative Care

Orogastric tube is left in place for drainage
Oral feedings not given until
- Bowel sounds are heard
- Stool is passed
- Gastric drainage is limited (<1 mL/kg/hr of clear or pale-green fluid).
Give total parenteral nutrition (TPN)

Preparation for surgery

Orogastric decompression of the stomach
Fluid resuscitation
Broad-spectrum antibiotics
1 mg vitamin K

Post Surgical Complications

The post surgical complications of duodenal atresia are as follows:^[4]^[5]^[6]

Post surgical complications include:
- Adhesions
- Blind loop syndrome
- Duodenal dysmotility
- Megaduodenum
- Duodenogastric reflux and gastritis
- Peptic ulcer disease
- Gastroesophageal reflux
- Cholelithiasis
- Cholecystitis

Contraindications

There are no contraindications to surgical repair of duodenal atresia.

References

↑ ^1.0 ^1.1 Freeman, SB; Torfs, CP; Romitti, PA; Royle, MH; Druschel, C; Hobbs, CA; Sherman, SL (2009). "Congenital gastrointestinal defects in Down syndrome: a report from the Atlanta and National Down Syndrome Projects". Clinical Genetics. 75 (2): 180–184. doi:10.1111/j.1399-0004.2008.01110.x. ISSN 0009-9163.
↑ Kay, Saundra; Yoder, Suzanne; Rothenberg, Steve (2009). "Laparoscopic duodenoduodenostomy in the neonate". Journal of Pediatric Surgery. 44 (5): 906–908. doi:10.1016/j.jpedsurg.2009.01.025. ISSN 0022-3468.
↑ Morris, Grant; Kennedy, Alfred; Cochran, William (2016). "Small Bowel Congenital Anomalies: a Review and Update". Current Gastroenterology Reports. 18 (4). doi:10.1007/s11894-016-0490-4. ISSN 1522-8037.
↑ Spigland N, Yazbeck S (1990). "Complications associated with surgical treatment of congenital intrinsic duodenal obstruction". J Pediatr Surg. 25 (11): 1127–30. PMID 2273425.
↑ Kokkonen ML, Kalima T, Jääskeläinen J, Louhimo I (1988). "Duodenal atresia: late follow-up". J Pediatr Surg. 23 (3): 216–20. PMID 3357136.
↑ Bishay, M.; Lakshminarayanan, B.; Arnaud, A.; Garriboli, M.; Cross, K. M.; Curry, J. I.; Drake, D.; Kiely, E. M.; De Coppi, P.; Pierro, A.; Eaton, S. (2012). "The role of parenteral nutrition following surgery for duodenal atresia or stenosis". Pediatric Surgery International. 29 (2): 191–195. doi:10.1007/s00383-012-3200-9. ISSN 0179-0358.

Template:WH Template:WS

[FreemanTorfs2009-1] 1.0 ^1.1 Freeman, SB; Torfs, CP; Romitti, PA; Royle, MH; Druschel, C; Hobbs, CA; Sherman, SL (2009). "Congenital gastrointestinal defects in Down syndrome: a report from the Atlanta and National Down Syndrome Projects". Clinical Genetics. 75 (2): 180–184. doi:10.1111/j.1399-0004.2008.01110.x. ISSN 0009-9163.

[KayYoder2009-2] Kay, Saundra; Yoder, Suzanne; Rothenberg, Steve (2009). "Laparoscopic duodenoduodenostomy in the neonate". Journal of Pediatric Surgery. 44 (5): 906–908. doi:10.1016/j.jpedsurg.2009.01.025. ISSN 0022-3468.

[MorrisKennedy2016-3] Morris, Grant; Kennedy, Alfred; Cochran, William (2016). "Small Bowel Congenital Anomalies: a Review and Update". Current Gastroenterology Reports. 18 (4). doi:10.1007/s11894-016-0490-4. ISSN 1522-8037.

[pmid2273425-4] Spigland N, Yazbeck S (1990). "Complications associated with surgical treatment of congenital intrinsic duodenal obstruction". J Pediatr Surg. 25 (11): 1127–30. PMID 2273425.

[pmid3357136-5] Kokkonen ML, Kalima T, Jääskeläinen J, Louhimo I (1988). "Duodenal atresia: late follow-up". J Pediatr Surg. 23 (3): 216–20. PMID 3357136.

[BishayLakshminarayanan2012-6] Bishay, M.; Lakshminarayanan, B.; Arnaud, A.; Garriboli, M.; Cross, K. M.; Curry, J. I.; Drake, D.; Kiely, E. M.; De Coppi, P.; Pierro, A.; Eaton, S. (2012). "The role of parenteral nutrition following surgery for duodenal atresia or stenosis". Pediatric Surgery International. 29 (2): 191–195. doi:10.1007/s00383-012-3200-9. ISSN 0179-0358.

[1]

[2]

[3]

[4]

[5]

[6]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Duodenal atresia}}
-{{CMG}}; {{AE}}
+{{CMG}}; {{AE}} {{HQ}}
+<div style="-webkit-user-select: none;">
+{| class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;"
+|-
+| {{#ev:youtube|https://www.youtube.com/watch?v=xxfAEwmVPbk|350}}
+|-
+|}
 ==Overview==
-Surgical intervention is not recommended for the management of [disease name].
+[[Surgery]] is the mainstay of treatment for duodenal atresia. A [[Nasogastric intubation|nasogastric]] or orogastric tube should be inserted to [[Decompression|decompress]] the [[abdomen]]. A [[laparotomy]] or [[Laparoscopic surgery|laparoscopy]] can be performed to correct duodenal atresia. [[Surgical]] procedures for the correction of duodenal atresia include duodenoduodenostomy and duodenojejunostomy.
-OR
+==Indications==
+[[Surgery]] is the first-line treatment option for patients with duodenal atresia. If the case is confirmed by: <ref name="FreemanTorfs2009">{{cite journal|last1=Freeman|first1=SB|last2=Torfs|first2=CP|last3=Romitti|first3=PA|last4=Royle|first4=MH|last5=Druschel|first5=C|last6=Hobbs|first6=CA|last7=Sherman|first7=SL|title=Congenital gastrointestinal defects in Down syndrome: a report from the Atlanta and National Down Syndrome Projects|journal=Clinical Genetics|volume=75|issue=2|year=2009|pages=180–184|issn=00099163|doi=10.1111/j.1399-0004.2008.01110.x}}</ref>
-Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
+*[[Ultrasound]]: shows duodenal obstruction
+*[[Abdomen|Abdominal]] [[X-rays|x-ray]]: shows air fluid levels
+==Surgery==
-OR
+[[Surgery]] is the mainstay of treatment for duodenal atresia.<ref name="FreemanTorfs2009">{{cite journal|last1=Freeman|first1=SB|last2=Torfs|first2=CP|last3=Romitti|first3=PA|last4=Royle|first4=MH|last5=Druschel|first5=C|last6=Hobbs|first6=CA|last7=Sherman|first7=SL|title=Congenital gastrointestinal defects in Down syndrome: a report from the Atlanta and National Down Syndrome Projects|journal=Clinical Genetics|volume=75|issue=2|year=2009|pages=180–184|issn=00099163|doi=10.1111/j.1399-0004.2008.01110.x}}</ref><ref name="KayYoder2009">{{cite journal|last1=Kay|first1=Saundra|last2=Yoder|first2=Suzanne|last3=Rothenberg|first3=Steve|title=Laparoscopic duodenoduodenostomy in the neonate|journal=Journal of Pediatric Surgery|volume=44|issue=5|year=2009|pages=906–908|issn=00223468|doi=10.1016/j.jpedsurg.2009.01.025}}</ref><ref name="MorrisKennedy2016">{{cite journal|last1=Morris|first1=Grant|last2=Kennedy|first2=Alfred|last3=Cochran|first3=William|title=Small Bowel Congenital Anomalies: a Review and Update|journal=Current Gastroenterology Reports|volume=18|issue=4|year=2016|issn=1522-8037|doi=10.1007/s11894-016-0490-4}}</ref>
+* [[Laparotomy]] or [[Laparoscopic surgery|laparoscopy]] can be performed.
-The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
+*A [[Nasogastric tube|nasogastric]] or orogastric tube should be inserted to decompress the [[abdomen]].
-OR
+[[Surgery|Surgical]] procedures include:
+*Side-to-side duodenoduodenostomy
+**Bypass procedure
+**Diamond-shaped [[anastomosis]] is constructed between the [[Anatomical terms of location|proximal]] [[Anatomical terms of location|transverse]] to the [[Anatomical terms of location|distal]] longitudinal [[anastomosis]]
+*End-to-side duodenoduodenostomy
+**Bypass procedure
+**Diamond-shaped anastomosis is constructed between the [[Anatomical terms of location|proximal]] [[Anatomical terms of location|transverse]] to the [[Anatomical terms of location|distal]] [[longitudinal]] [[anastomosis]]
+*Duodenojejunostomy
+===Post Operative Care===
+*Orogastric tube is left in place for drainage
+*Oral feedings not given until
+**[[Intestine|Bowel]] sounds are heard
+**[[Human feces|Stool]] is passed
+**[[Stomach|Gastric]] drainage is limited (<1 mL/kg/hr of clear or pale-green fluid).
+*Give [[total parenteral nutrition]] ([[Total parenteral nutrition|TPN]])
-The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
+===Preparation for surgery===
+*Orogastric decompression of the [[stomach]]
-OR
+*[[Fluid replacement|Fluid resuscitation]]
+*[[Broad-spectrum antibiotic|Broad-spectrum antibiotics]]
-Surgery is the mainstay of treatment for [disease or malignancy].
+*1 mg [[vitamin K]]
-==Indications==
-*Surgery is the first-line treatment option for patients with duodenal atresia.
-**Ultrasound shows duodenal obstruction
-**Abdominal x-ray shows air fluid levels
-==Surgery==
-Surgery is the mainstay of treatment for duodenal atresia.
+===Post Surgical Complications===
-*Laparotomy
+The post [[Surgery|surgical]] complications of duodenal atresia are as follows:<ref name="pmid2273425">{{cite journal| author=Spigland N, Yazbeck S| title=Complications associated with surgical treatment of congenital intrinsic duodenal obstruction. | journal=J Pediatr Surg | year= 1990 | volume= 25 | issue= 11 | pages= 1127-30 | pmid=2273425 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2273425  }} </ref><ref name="pmid3357136">{{cite journal| author=Kokkonen ML, Kalima T, Jääskeläinen J, Louhimo I| title=Duodenal atresia: late follow-up. | journal=J Pediatr Surg | year= 1988 | volume= 23 | issue= 3 | pages= 216-20 | pmid=3357136 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3357136  }} </ref><ref name="BishayLakshminarayanan2012">{{cite journal|last1=Bishay|first1=M.|last2=Lakshminarayanan|first2=B.|last3=Arnaud|first3=A.|last4=Garriboli|first4=M.|last5=Cross|first5=K. M.|last6=Curry|first6=J. I.|last7=Drake|first7=D.|last8=Kiely|first8=E. M.|last9=De Coppi|first9=P.|last10=Pierro|first10=A.|last11=Eaton|first11=S.|title=The role of parenteral nutrition following surgery for duodenal atresia or stenosis|journal=Pediatric Surgery International|volume=29|issue=2|year=2012|pages=191–195|issn=0179-0358|doi=10.1007/s00383-012-3200-9}}</ref>
-*Laparoscopy
-Surgical procedures include:
+*Post surgical complications include:
-*side-to-side duodenoduodenostomy
+**[[Adhesion (medicine)|Adhesions]]
-**bypass procedure
+**[[Blind loop syndrome]]
-**diamond-shaped anastomosis is constructed between the proximal transverse to the distal longitudinal anastomosis
+**[[Duodenum|Duodenal]] dysmotility
-*end-to-side duodenoduodenostomy
+**[[Megaduodenum]]
-**bypass procedure
+**Duodenogastric reflux and [[gastritis]]
-**diamond-shaped anastomosis is constructed between the proximal transverse to the distal longitudinal anastomosis
+**[[Peptic ulcer|Peptic ulcer disease]]
-*duodenojejunostomy
+**[[Gastroesophageal reflux disease|Gastroesophageal reflux]]
+**[[Gallstone disease|Cholelithiasis]]
+**[[Chronic cholecystitis|Cholecystitis]]
 ==Contraindications==
+There are no contraindications to surgical repair of duodenal atresia.
 ==References==
@@ Line 50: / Line 68: @@
 {{WH}}
 {{WS}}
-[[Category: (name of the system)]]
+[[Category:Gastroenterology]]
+[[Category:Surgery]]
+[[Category:Disease]]
+[[Category:Pediatrics]]
+[[Category:Up-To-Date]]