Duodenal atresia surgery: Difference between revisions
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==Overview== | ==Overview== | ||
[[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 include duodenoduodenostomy | [[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. | ||
==Indications== | ==Indications== | ||
[[Surgery]] is the first-line treatment option for patients with 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> | [[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> | ||
*[[Ultrasound]] shows duodenal obstruction | *[[Ultrasound]]: shows duodenal obstruction | ||
*[[Abdomen|Abdominal]] [[X-rays|x-ray]] shows air fluid levels | *[[Abdomen|Abdominal]] [[X-rays|x-ray]]: shows air fluid levels | ||
==Surgery== | ==Surgery== | ||
[[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> | [[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. | |||
*A [[Nasogastric tube|nasogastric]] or orogastric tube should be inserted to decompress the [[abdomen]]. | *A [[Nasogastric tube|nasogastric]] or orogastric tube should be inserted to decompress the [[abdomen]]. | ||
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**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]] | **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 | *Duodenojejunostomy | ||
===Post Operative Care=== | ===Post Operative Care=== | ||
*Orogastric tube is left in place for drainage | *Orogastric tube is left in place for drainage | ||
*Oral feedings not given until | *Oral feedings not given until | ||
** | **[[Intestine|Bowel]] sounds are heard | ||
** | **[[Human feces|Stool]] is passed | ||
**Gastric drainage is limited (<1 mL/kg/hr of clear or pale-green fluid). | **[[Stomach|Gastric]] drainage is limited (<1 mL/kg/hr of clear or pale-green fluid). | ||
*Give total parenteral nutrition (TPN) | *Give [[total parenteral nutrition]] ([[Total parenteral nutrition|TPN]]) | ||
===Preparation for surgery=== | |||
*Orogastric decompression of the [[stomach]] | |||
*[[Fluid replacement|Fluid resuscitation]] | |||
*[[Broad-spectrum antibiotic|Broad-spectrum antibiotics]] | |||
*1 mg [[vitamin K]] | |||
===Post Surgical Complications=== | ===Post Surgical Complications=== | ||
The post 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> | 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> | ||
*Post surgical complications include: | *Post surgical complications include: | ||
**Adhesions | **[[Adhesion (medicine)|Adhesions]] | ||
**Duodenal dysmotility | **[[Blind loop syndrome]] | ||
**Megaduodenum | **[[Duodenum|Duodenal]] dysmotility | ||
**Duodenogastric reflux and gastritis | **[[Megaduodenum]] | ||
**Peptic ulcer disease | **Duodenogastric reflux and [[gastritis]] | ||
**Gastroesophageal reflux | **[[Peptic ulcer|Peptic ulcer disease]] | ||
**Cholelithiasis | **[[Gastroesophageal reflux disease|Gastroesophageal reflux]] | ||
**Cholecystitis | **[[Gallstone disease|Cholelithiasis]] | ||
**[[Chronic cholecystitis|Cholecystitis]] | |||
==Contraindications== | ==Contraindications== | ||
Latest revision as of 19:44, 5 January 2018
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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
- 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.