Mumtaz Hussain, Naila Yaqub.
Duodenal Atresia and Annular Pancreas in a very low Birth Weight Baby.
J Coll Physicians Surg Pak Jan ;10(10):401-2.

A very low birth weight (1.4kg) female baby of five days, with duodenal obstruction due to duodenal atresia and annular pancreas was operated. Duodenojejunostomy was done to restore the intestinal continuity. The patient had an uneventful course and was discharged after two weeks of hospitalization. At follow- up patient failed to put on weight and on investigation found to have gastroesophageal reflux. Surgery was advised but parents declined.

CASE REPORT: A three-day old very low birth weight (1.4 kg) female baby was admitted with history of persistent bilious vomiting since birth. The diagnosis of aspiration pneumonia with septicemia was made by treating physician. After 24 hours, nasogastric aspiration stopped and oral feed was tried, but the baby vomitted again. After another 24 hours, oral feed was started but the baby again developed bilious vomiting. Baby also developed jaundice. Gross associated anomalies were not present. X-ray abdomen showed double bubble sign indicating obstruction at the duodenal level. At laparotomy marked thickening of wall and dilatation of proximal duodenum and stomach found. Duodenal atresia with annular pancreas was present. There were no other associated visceral anomalies. Duodenoduodenostomy was considered initially but distal duodenum was not identifiable despite Kocker maneuver. Thus, duodenojejunostomy was performed. Postoperatively, she was managed in NICU. Parenteral nutrition was started after 24 hours of surgery. Expressed breast milk was started after 5th postoperative day. On 8th postoperative day, the baby was on full breast feed. Generalized edema was noted after the fourth postoperative day, which subsided gradually when oral intake was increased to full breast feed. The weight of the baby increased from 1.4 kg to 2 kg on 10th postoperative day. The baby was discharged home after a fortnight of hospitalization. At follow-up it was noted that patient is not thriving and is vomiting repeatedly. The diagnosis of gastroesophageal reflux was made and confirmed by contrast study. The patient was initially managed non-operatively but there was no improvement. Antireflux surgery was planned but the parents declined and the patient was lost to follow-up.

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