Megaduodenum in children in the outcom of correction of duadenal atreesia: literature review and own experience

Abstract

Introduction. Despite the good long-term results of duodenal atresia correction in the long term, about 10% of patients have severe upper gastrointestinal motility disorders: GERD, gastroduodenitis, and megaduodenum, which requires re-reconstruction of the duodenal anastomosis. Materials and methods. For the period from 2010 to 2021 in the clinic of the FGBUZ DGKB them. N. F. Filatov DZM Moscow 7 patients was treated with megaduodenum, operated on for duodenal atresia. The average age of the patients was 5.4 ± 3.9, boys predominated (6/7). All children underwent a standardized examination: ultrasound, barium fluoroscopy, FGEDS and laboratory research methods. MRCP and abdominal CT were performed as indicated (3/7). All patients were operated on, depending on the cause of obstruction and the degree of its compensation. Reconstruction of the previously applied anastomosis (4/7) or resection of the duodenum (3/7) was performed. Results. Main patient complaints: abdominal pain 7/7 (100%), vomiting 7/7 (100%), abdominal distention 4/7 (57.1%), poor weight loss 3/7 (42.8%), constipation 3/7 (42.8%). 5 out of 7 had multiple congenital malformations (MCDs). Mechanical causes of chronic renal failure were detected in 4 out of 7 children: stenosis of the duodeno-duodenoanastomosis (2), “blind loop” syndrome (infringement of the Roux loop in the form of a “double-barrel” in the window of the mesentery of the transverse colon) (1), stenosis of the duodeno-duodenoanastomosis in in combination with fibrosis of the head of the pancreas (1). In the remaining 3 cases a secondary megaduodenum was detected with good obstruction of the previously imposed anastomosis. Hiowever, it was noted that the diameter of the anastomosis was definitely less than the diameter of the duodenum above its level. In 6 out of 7 patients chronic renal failure was complicated by secondary gastroesophageal reflux disease (GERD), which required surgical correction in only one patient after 6 months. In other cases, the dynamics of reflux spontaneously decreased to 1 degree and was intermittent, the patients had no complaints. All children were examined in follow-up after 1, 3, 6 and 12 months. All of them showed positive dynamics in the form of weight gain, absence of complaints and signs of protein-energy insufficiency. Conclusion. Children operated on for duodenal atresia need long-term careful dispensary observation. Since in the presence of pronounced motor-evacuation disorders of the duodenum, repeated interventions are necessary. Surgical tactics should be strictly differentiated. Resection of the duodenum improves passage through the upper gastrointestinal tract and is well tolerated by patients.