Duodenal atresia and stenosis

Abstract

Duodenal atresia and stenosis are classified into intrinsic and extrinsic obstruction. Intrinsic obstruction includes congenital duodenal atresia and stenosis, and extrinsic obstruction includes malrotation and SMA syndrome. Because of high incidence of associated anomalies, an evaluation of associated diseases is mandatory before operation. The most common classification of duodenal atresia divides these anomalies into three categories based on the type of the obstruction: Membrane, fibrous cord, and complete separation. A proximal transverse to distal longitudinal (diamond-shaped) duodenoduodenostomy is the most common procedure regardless of the type of obstruction. When there is continuity of the muscular coats of the bowel, the best surgical approach is membranectomy because of the physiologic anatomy after operation. The surgeon should identify the location of the papilla Vater by compression of the gallbladder to see where the bile enters the duodenum before and after anastomosis. A trans-anastomotic feeding tube is passed down to the level of the proximal jejunum to detect another obstruction caused by a second duodenal mucosal web. This tube can help an early establishment of enteral feeding postoperatively.