Treatment of children with incomplete duodenal membrane

Abstract

BACKGRAUND: An incomplete or perforated duodenal membrane is a rare developmental pathology of the gastrointestinal tract. AIM: This study aimed to analyze the diagnostic and treatment results of children with an incomplete duodenal membrane in the Republican Childrens Clinical Hospital in Ufa. MATERIALS AND METHODS: This study retrospectively analyzed case histories of 34 children who underwent surgery for incomplete duodenal membrane from 2005 to 2020. Features of the life history of the children, clinical picture of the disease, presence of concomitant developmental anomalies, laboratory and instrumental examination data, surgical correction methods, and postoperative period were analyzed. All children underwent ultrasound examination of the abdominal organs and contrast-enhanced radiography of the upper gastrointestinal tract with barium sulfate. Esophagogastroduodenoscopy was performed in 17 cases. RESULTS: Antenatally, the diagnosis was made in 21 cases. Patients age at the time of hospitalization was 9.7 2.7 days. Children were presented with symptoms such as persistent regurgitation or vomiting of curdled milk, which was sometimes mixed with bile (22 cases). Bloating in the epigastric region, retraction of the lower abdomen, and low weight gain after birth were found in nine children, and in five children, no weight changes were observed. Moreover, 13 (38.2%) children had concomitant developmental anomalies; 4 (11.7%) children had Down syndrome. Surgical treatment of 10 children was performed laparoscopically. Of the 24 children, three received laparotomic access, including conversion. The procedures included duodenotomy, partial excision of the membrane, and suturing of the duodenum. Enteral feeding was started 4.9 0.6 days after surgery. The average duration of hospitalization was 27 1.4 days. CONCLUSION: Vomiting or frequent regurgitation in infants and low-weight gain should alert pediatricians and pediatric surgeons. Malformation of the duodenal membrane in combination with other malformations necessitates a comprehensive examination. Laparoscopic excision of the duodenal membrane is the preferred treatment.