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384 Duodenal Atresia and Stenosis
Prognosis Table 62.1: Evidence-based research.
Although prognosis of intestinal atresia in general is good, an overall Title Diamond-shaped anastomosis for duodenal atresia: an
mortality of 7% for duodenal obstruction is shown in large series. 6 experience with 44 patients over 15 years
Associated congenital anomalies are identified as an independent risk Authors Kimura K, Mukohara N, Nishijima E, Muraji T, Tsugawa C,
factor for an impaired clinical course. Low birth weight and the prob- Matsumoto Y
lems of prematurity further increase mortality risk. Institution Department of Surgery, Kobe Children’s Hospital, Kobe,
The morbidity and mortality of neonatal intestinal obstruction Japan
is higher in Africa (40%) than in developed countries and is most Reference J Pediatr Surg 1990; 25(9):977–979
likely due to late patient presentation and poor neonatal intensive care Problem Role of diamond-shaped anastomosis in the treatment of
facilities available in many countries in the continent. 3 duodenal atresia and stenosis.
Conclusion Intervention Duodenoduodenostomy via diamond-shaped anastomosis.
The morbidity and mortality of intestinal obstruction can be improved Comparison/ In this retrospective observational study, 44 patients over a
with earlier referral to specialty centres and with meticulous resuscitation control 15-year period were examined for outcome after diamond
shaped anastomosis. All patients underwent this method of
before surgery. Duodenoduodenostomy or duodenotomy with membrane (quality of repair, so there was no control group.
resection in the appropriate circumstance are the typical operations of evidence)
choice and produce good results with minimal short- or long-term oper- Outcome/ In all patients, oral feedings were commenced 3.66 ± 1.4
ative-related morbidity. Problems of late presentation and poor neonatal effect days postoperatively (range, 2 to 6). There was no operative-
related mortality. Twenty-one patients had long-term follow-up
intensive care facilities constitute the basis for the variance in outcomes from 6 months to 15 years. All patients had normal body
in Africa when compared to those in developed countries. 7 weight for their age at last record, and current upper GI
Nevertheless, even in Europe and North America, the outcome for contrast study (done in 19 of 21 patients) revealed normal
calibre of duodenum and anastomosis in all studied cases.
children with duodenal obstruction is basically influenced by the degree
of prematurity and the presence of associated anomalies. Historical This study, reported by the originator of the diamond-
significance/ shaped anastomosis, states the efficacy of this technique in
Evidence-Based Research comments duodenal atresia. Given the relative rarity off the disorder,
this report offers a substantial collection of patients with a
Table 62.1 is an observational 15-year retrospective study of the use of prolonged follow-up period. Although a comparison group
diamond-shaped anastomosis for duodenal atresia. who underwent traditional side-to-side anastomosis was not
included here, the results compare favorably to previously
published reports of side-to-side anastomotic techniques.
Because of its technical ease and its potential to allow
early recovery of enteral function without excessive late
complications, this technique may be of particular use in
undeveloped regions where opportunity for follow-up care
is limited.

Key Summary Points
1. Obstructions of duodenum can be intrinsic or extrinsic. 6. Postnatal plain radiograph revealing a double bubble (distended
2. There is a high incidence of prematurity and associated anomalies, stomach and proximal duodenum) without evidence of distal gas
in the appropriate clinical setting is essentially pathognomic for
including cardiac and renal defects as well as Down syndrome.
duodenal atresia.
3. Prenatal ultrasound can be very helpful and may reveal 7. Repair for all forms of duodenal obstruction can be
maternal polyhydramnios or a “double-bubble”.
accomplished through side-to-side or diamond-shaped
4. Physical signs are nonspecific but can include upper- anastomosis proximal and distal to the obstruction. Additionally,
abdominal distention with scaphoid lower abdomen. duodenal webs can be approached through partial resection of
5. The most important differential diagnosis to consider is the membrane itself.
duodenal obstruction due to malrotation, resulting in volvulus of
the midgut loop

References
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