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Journal of Neonatal Surgery 2016Congenital duodenal obstruction is one of the commonest causes of neonatal intestinal obstruction. We are presenting our 15-year experience by analyzing clinical...
BACKGROUND
Congenital duodenal obstruction is one of the commonest causes of neonatal intestinal obstruction. We are presenting our 15-year experience by analyzing clinical spectrum and outcome in neonates with duodenal obstruction admitted at our center.
MATERIAL AND METHODS
The hospital records of all neonates admitted with duodenal obstruction from June 2000 to June 2015 were reviewed. The patient records were analyzed for antenatal diagnosis, age, sex, clinical presentation, diagnosis, associated anomalies, surgical procedures performed; postoperative morbidity and mortality. We excluded from our study malrotation of gut associated with congenital diaphragmatic hernia and abdominal wall defects.
RESULTS
A total of 81 patients were admitted, out of which 56 were males and 25 were females. Polyhydramnios was detected in 24 (30%) pregnancies. Average birth weight was 2.1±1.0Kg and average gestational age was 38 (SD±1) weeks with 17 (21%) preterm neonates. Presenting features were vomiting in 81(100%) which was bilious in 81% and non-bilious in 19%, epigastric fullness in 56 (69%) and dehydration in 18 (22%) and failure to thrive in 16 (19%). Most common cause of obstruction was duodenal atresia in 38 (46.9%), followed by malrotation of gut in 33 (40.7%), and annular pancreas in 4 cases. Depending upon site of location, infra-ampullary obstruction was the most common in 64 (79%), supra-ampullary in 9 (7.4%) and ampullary 8 neonates. Both duodenal atresia and malrotation of gut was present in 4 cases. X-ray abdomen was most commonly used investigation to confirm the diagnosis. All cases were managed surgically by open laparotomy. Eleven (13.5%) patients died due to sepsis and associated congenital anomalies.
CONCLUSION
Congenital duodenal obstruction most commonly presents in early neonatal period with features of upper GIT obstruction like vomiting and epigastrium fullness as in our series. Early antenatal diagnosis and surgical interventions hold the key in achieving good outcome. Associated congenital anomalies, prematurity, sepsis and delayed presentation are the main risk factors for post-operative mortality and morbidity.
PubMed: 27123397
DOI: No ID Found -
Journal of Medical Ultrasonics (2001) Apr 2022This study aimed to evaluate the diagnostic performance of ultrasound to locate atresia/stenosis and other abdominal anomalies in pediatric patients with duodenal...
The diagnostic accuracy of ultrasound and upper gastrointestinal contrast studies for locating atresia/stenosis and intestinal malrotation and detecting annular pancreas in pediatric patients with duodenal atresia/stenosis.
PURPOSE
This study aimed to evaluate the diagnostic performance of ultrasound to locate atresia/stenosis and other abdominal anomalies in pediatric patients with duodenal atresia/stenosis, including intestinal malrotation and annular pancreas.
METHODS
We classified 36 retrospective cases of duodenal atresia/stenosis based on intestinal malrotation status, and evaluated the diagnostic performance of ultrasound/upper gastrointestinal contrast studies to locate atresia/stenosis and intestinal malrotation, as well as ultrasound for detecting additional anomalies such as annular pancreas. The incidence of annular pancreas was compared between groups using Fisher's exact test.
RESULTS
Atresia/stenosis was correctly located by ultrasound in 33 (91.7%) cases and by upper gastrointestinal contrast study in 36 (100%) cases. Of the eight cases with intestinal malrotation, five and two were correctly diagnosed by ultrasound and upper gastrointestinal contrast study, respectively. Ultrasound correctly diagnosed annular pancreas in 6/14 cases. The incidence of annular pancreas was significantly different between the groups (present/absent in groups with vs. without intestinal malrotation: 6/2 vs. 8/20, P = 0.036).
CONCLUSIONS
Ultrasound has a relatively high capability in locating atresia/stenosis. However, some cases are misdiagnosed. In clinical practice, upper gastrointestinal contrast studies should be used complementarily during diagnosis. Additional anomalies may not be detected by preoperative examinations; therefore, surgeons should carefully evaluate for additional anomalies during surgery, especially coexisting intestinal malrotation and annular pancreas.
Topics: Child; Constriction, Pathologic; Contrast Media; Digestive System Abnormalities; Duodenal Obstruction; Humans; Intestinal Atresia; Intestinal Volvulus; Pancreas; Pancreatic Diseases; Retrospective Studies
PubMed: 34988762
DOI: 10.1007/s10396-021-01176-1 -
Surgical and Radiologic Anatomy : SRA Apr 2018To determine the frequency of circumportal pancreas (CP), and accompanying ductal and vascular anatomy variations.
PURPOSE
To determine the frequency of circumportal pancreas (CP), and accompanying ductal and vascular anatomy variations.
METHODS
Thin-section multidetector computed tomography of 6813 consecutive patients was retrospectively reviewed. Two radiologists evaluated CP presence with consensus. Concomitant pancreatic ductal and vascular variations were recorded. The course of the pancreatic duct was classified according to the portal vein as anteportal and retroportal, and pancreas fusion level classified according to splenic vein as suprasplenic, infrasplenic and mixed type.
RESULTS
A total of 55 (0.8%) CP cases were detected. Six suprasplenic subtype cases were excluded from the classification, because the pancreatic ducts were not clearly distinguishable. Suprasplenic anteportal (45/49, 92%), infrasplenic anteportal (2/49, 4%), suprasplenic retroportal (1/49, 2%), and mixed anteportal subtypes (1/49, 2%) were detected. There were vascular variations in 16 cases (29%). 13/16 (81%) of vascular variations were detected on suprasplenic anteportal subtype. Most of them were replaced right hepatic artery from the superior mesenteric artery (n: 6).
CONCLUSIONS
CP is a rare but important pancreatic fusion anomaly. Suprasplenic anteportal CP is the most common subtype and other subtypes are very rare. Replaced right hepatic artery from the superior mesenteric artery is the most frequent vascular variation associated with CP. Identifying the CP and defining the pancreatic duct and vascular variations are important to prevent possible complications in patients undergoing pancreatic surgery.
Topics: Adult; Aged; Aged, 80 and over; Anatomic Variation; Female; Humans; Male; Middle Aged; Multidetector Computed Tomography; Pancreas; Prevalence; Retrospective Studies
PubMed: 29380102
DOI: 10.1007/s00276-018-1975-7 -
Gene Expression Patterns : GEP Sep 2021The pancreas development depends on complex regulation of several signaling pathways, including the Hedgehog (Hh) signaling via a receptor complex component, Smoothened,...
The pancreas development depends on complex regulation of several signaling pathways, including the Hedgehog (Hh) signaling via a receptor complex component, Smoothened, which deficiency blocks the Hh signaling. Such a defect in birds and mammals results in an annular pancreas. We showed that in developing zebrafish, the mutation of Smoothened or inhibition of Hh signaling by its antagonist cyclopamine caused developmental defects of internal organs, liver, pancreas, and gut. In particular, the pancreatic primordium was duplicated. The two exocrine pancreatic primordia surround the gut. This phenomenon correlates with a significant reduction of the gut's diameter, causing the annular pancreas phenotype.
Topics: Animals; Hedgehog Proteins; Pancreas; Signal Transduction; Smoothened Receptor; Zebrafish; Zebrafish Proteins
PubMed: 34087472
DOI: 10.1016/j.gep.2021.119185 -
JAMA Surgery Jun 2016
Topics: Aged; Diagnosis, Differential; Female; Gastric Outlet Obstruction; Humans; Pancreas; Pancreatic Diseases; Tomography, X-Ray Computed
PubMed: 27120120
DOI: 10.1001/jamasurg.2016.0232 -
The Korean Journal of Gastroenterology... Apr 2022Annular pancreas is a rare congenital anomaly in which a thin band of pancreatic tissue partially or completely surrounds the duodenum. It is challenging to diagnose due...
Annular pancreas is a rare congenital anomaly in which a thin band of pancreatic tissue partially or completely surrounds the duodenum. It is challenging to diagnose due to its variable clinical presentation. Approximately two-thirds of patients have no symptoms in their lifetime, and most symptomatic cases are seen in neonates and infants. Symptomatic adult patients present with upper gastrointestinal symptoms, such as epigastric pain, vomiting, and postprandial fullness associated with gastric outlet obstruction. Complications associated with annular pancreas include peptic ulcer disease, pancreatitis, pancreatic head carcinoma, and biliary obstruction. Annular pancreas is also a rare cause of upper gastrointestinal bleeding in adults, but it should be considered as one of the differential diagnoses in patients presenting with a peptic ulcer and duodenal stricture. Here, we report the case of a 60-year-old man who presented with melena and was subsequently diagnosed with an annular pancreas.
Topics: Adult; Gastrointestinal Hemorrhage; Humans; Infant, Newborn; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Peptic Ulcer
PubMed: 35473777
DOI: 10.4166/kjg.2022.012 -
Journal of Minimal Access Surgery 2020Annular pancreas is a rare, congenital, rotational anomaly of pancreas, seen usually in newborns who present with features of duodenal obstruction. However, in adults,...
BACKGROUND
Annular pancreas is a rare, congenital, rotational anomaly of pancreas, seen usually in newborns who present with features of duodenal obstruction. However, in adults, only 24% of cases are present with duodenal obstruction. Surgery remains the procedure of choice in patients in whom symptoms can be attributed to duodenal obstruction and the goal of surgery is to relieve obstruction by bypassing the annulus. Laparoscopic Roux-en Y duodenostomy (DJ) is our preferred bypass approach for this condition. Literature search revealed that very few case reports have been published about laparoscopic management of annular pancreas, especially about duodenojejunal anastomosis. We present our experience in the laparoscopic management of symptomatic annular pancreas in adults and technique of the laparoscopic Roux-en Y DJ for annular pancreas.
MATERIALS AND METHODS
Between 1996 and 2016, a total of six adult patients underwent laparoscopic management for symptomatic annular pancreas. The demographic, perioperative and follow-up details were documented.
RESULTS
All surgeries were successfully performed by laparoscopic approach with no conversion to open. Five cases underwent Roux-en Y DJ and one underwent gastrojejunostomy. No major perioperative events occurred. The mean length of hospital stay was 5.6 days. Five out of six patients were followed up for 24 months, and no symptom recurrence was seen.
CONCLUSION
Laparoscopic Roux-en Y duodenojejunostomy could be used as a safe and physiological treatment for annular pancreas in adult patients and should be preferred for the treatment of duodenal obstruction due to annular pancreas.
PubMed: 30618433
DOI: 10.4103/jmas.JMAS_245_18 -
Pediatric Surgery International Oct 2020The aim of the study is to assess the value of saline-aided ultrasound (US) in diagnosing congenital duodenal obstruction (CDO).
PURPOSE
The aim of the study is to assess the value of saline-aided ultrasound (US) in diagnosing congenital duodenal obstruction (CDO).
METHODS
The neonates with CDO were enrolled in this study, including the neonates confirmed with annular pancreas (AP) by operation, the neonates confirmed with duodenal atresia, the neonates confirmed with duodenum web, and the neonates confirmed with malrotation. Pertinent data were recorded, including the US features, intraoperative findings, and surgical procedures. The methodology of this study is a diagnostic test study which means the US feature is the test and the intraoperative finding is the gold standard.
RESULTS
A total of 95 neonates were enrolled, including 33 neonates with AP, 6 neonates with duodenal atresia, 29 neonates with duodenum web, and 27 neonates with malrotation. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the hyperechogenic band for the detection of AP were 78.8% (26/33), 90.3% (56/62), 81.2% (26/32), 88.8% (56/63), and 86.3% (82/95), respectively. The sensitivity, specificity, NPV, and accuracy for the detection of duodenal atresia were 0% (0/6), 100% (89/89), 93.6% (89/95), and 93.6% (89/95), respectively. The sensitivity, specificity, PPV, NPV, and accuracy for the detection of duodenum web were 100% (29/29), 100% (66/66), 100% (29/29), 100% (66/66), and 100% (95/95), respectively. The sensitivity, specificity, PPV, NPV, and accuracy for the detection of malrotation were 100% (27/27), 100% (68/68), 100% (27/27), 100% (68/68), and 100% (95/95), respectively.
CONCLUSION
Saline-aided US is a feasible tool to diagnose CDO.
Topics: Duodenal Obstruction; Feasibility Studies; Female; Humans; Infant, Newborn; Laparoscopy; Male; ROC Curve; Ultrasonography
PubMed: 32715324
DOI: 10.1007/s00383-020-04723-y -
Pediatric Surgery International Aug 2018To summarize the clinical characteristics, diagnosis, treatment and prognosis among 152 children with annular pancreas (AP). A retrospective review of 152 patients with...
To summarize the clinical characteristics, diagnosis, treatment and prognosis among 152 children with annular pancreas (AP). A retrospective review of 152 patients with AP who were treated with surgical repair between January 2009 and August 2017 was performed at our pediatric surgical units. Presenting symptoms, birth weight, radiological findings, associated anomalies, the type of surgery performed were analyzed. (1) 152 patients were identified, out of which 82 were males, and 70 were females; (2) the average birth weight of children with AP was less than that of healthy newborns. The birth weights of 5.4% premature infants were less than 1500 g; the birth weight of 17% full-term infants, 69% premature infants and 50% post-term infants were less than 2500 g. (3) 100 (66%) patients presented symptoms during neonatal period and 43 (28%) patients had duodenal obstruction diagnosed by prenatal ultrasound scan. (4) All cases were managed surgically by open laparotomy, and all patients were duly discharged. AP most commonly presents symptoms in early neonatal period. Infants with AP are associated with a higher rate of low birth weight, and it was because swallowed amniotic fluid could not be absorbed and impaired insulin secretion caused by abnormal pancreas. Ultrasonography, abdominal plain film and upper gastrointestinal series (UGI) are helpful, but cannot make the diagnosis, and surgery is the only effective way to diagnose and treat AP.
Topics: Birth Weight; China; Chromosome Aberrations; Digestive System Abnormalities; Duodenal Obstruction; Duodenostomy; Female; Heart Defects, Congenital; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Male; Pancreas; Pancreatic Diseases; Retrospective Studies; Urinary Tract
PubMed: 29909441
DOI: 10.1007/s00383-018-4299-0 -
Revista de Gastroenterologia de Mexico... 2018
PubMed: 28527819
DOI: 10.1016/j.rgmx.2017.03.005