Naima Zamir, Jamshed Akhtar.
Neonatal Duodenal Obstruction: Clinical Presentation and Outcome.
J Surg Pak Jan ;18(4):182-5.

Objective: To find out causes, modes of presentations and surgical outcome in neonates with duodenal obstruction. Study design: Descriptive case series. Place & Duration of study: Department of Paediatric Surgery National Institute of Child Health (NICH) Karachi, from September 2011 to August 2013. Methodology: All neonates presenting with duodenal obstruction were included. Age at presentation, symptoms and signs, associated anomalies, treatment provided and outcome were recorded. Investigations done included CBC, serum electrolytes, urea / creatinine, x-ray abdomen and echocardiography. Surgical procedures were tailored according to the cause of obstruction. Data was recorded on a performa. Analysis was done using SPSS version 17. Results: A total of 17 patients (males 13, females 4) were managed. Age ranged from 1 day to 20 day (mean=4 day). Weight of the babies ranged from 1.5 kg to 3.0 kg (mean=2.24 kg). One patient was delivered via cesarean section. The causes of obstruction were duodenal atresia (n=8), annular pancreas with duodenal atresia (n=4), annular pancreas with duodenal atresia and malrotation (n=3) and only malrotation (n=2). Double duodenal atresia was present in one patient. Associated imperforate anus was found in five cases, multiple atresias of gut and jejunal atresia in one case each. Three patients had Down syndrome. All patients were operated. Two patients had anastomotic leak. A total of seven patients survived. Those who expired had duodenal atresia (n=5), annular pancreas group (n=4) and malrotation (n=1). Sepsis was the major contributor to the mortality. Conclusions: Late presentation with low birth weight were the salient observations. Multiple associated gut related surgical anomalies added to operative stress. High mortality (59%) was of concern and sepsis remained the major contributor.

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