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Archives of Disease in Childhood. Fetal... Feb 2024To determine the impact of transanastomotic tube (TAT) feeding in congenital duodenal obstruction (CDO). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the impact of transanastomotic tube (TAT) feeding in congenital duodenal obstruction (CDO).
DESIGN
Systematic review with meta-analysis.
PATIENTS
Infants with CDO requiring surgical repair.
INTERVENTIONS
TAT feeding following CDO repair versus no TAT feeding.
MAIN OUTCOME MEASURES
The main outcome was time to full enteral feeds. Additional outcomes included use of parenteral nutrition (PN), cost and complications from either TAT or central venous catheter. Meta-analyses were undertaken using random-effects models (mean difference (MD) and risk difference (RD)), and risk of bias was assessed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool.
RESULTS
Twelve out of 373 articles screened met the inclusion criteria. All studies were observational and two were prospective. Nine studies, containing 469 infants, were available for meta-analysis; however, four were excluded due to serious or critical risk of bias. TAT feeding was associated with reduced time to full enteral feeds (-3.34; 95% CI -4.48 to -2.20 days), reduced duration of PN (-6.32; 95% CI -7.93 to -4.71 days) and reduction in nutrition cost of £867.36 (95% CI £304.72 to £1430.00). Other outcomes were similar between those with and without a TAT including inpatient length of stay (MD -0.97 (-5.03 to 3.09) days), mortality (RD -0.01 (-0.04 to 0.01)) and requirement for repeat surgery (RD 0.01 (-0.03 to 0.05)).
CONCLUSION
TAT feeding following CDO repair appears beneficial, without increased risk of adverse events; however, certainty of available evidence is low. Earlier enteral feeding and reduced PN use are known to decrease central venous catheter-associated risks while significantly reducing cost of care.
PROSPERO REGISTRATION NUMBER
CRD42022328381.
Topics: Humans; Enteral Nutrition; Duodenal Obstruction; Prospective Studies; Parenteral Nutrition; Nutritional Status
PubMed: 37923385
DOI: 10.1136/archdischild-2023-325988 -
Annals of Hepatology 2007Obstruction at the level of the gastric outlet by a gallstone is defined as Bouveret's syndrome. It is an uncommon form of gallstone ileus. A single gallstone of at... (Review)
Review
Obstruction at the level of the gastric outlet by a gallstone is defined as Bouveret's syndrome. It is an uncommon form of gallstone ileus. A single gallstone of at least 2.5 cm in diameter is the most common underlying cause of Bouveret's syndrome. Diagnosis is based on the clinical manifestations, existence of pneumobilia, visualization of lithiasis and demonstration of duodenal obstruction. Enterotomy or gastrotomy with or without cholecystectomy and fistula repair is the most common surgical therapy. It has high success rate, with acceptable surgical morbidity and mortality. Heightened awareness of this syndrome may lead to decreased morbidity and mortality.
Topics: Duodenal Obstruction; Gallstones; Gastric Outlet Obstruction; Humans; Ileus; Syndrome
PubMed: 17519830
DOI: No ID Found -
Archives of Disease in Childhood. Fetal... Mar 2020Congenital duodenal obstruction (CDO) comprising duodenal atresia or stenosis is a rare congenital anomaly requiring surgical correction in early life. Identification of... (Observational Study)
Observational Study
OBJECTIVE
Congenital duodenal obstruction (CDO) comprising duodenal atresia or stenosis is a rare congenital anomaly requiring surgical correction in early life. Identification of variation in surgical and postoperative practice in previous studies has been limited by small sample sizes. This study aimed to prospectively estimate the incidence of CDO in the UK, and report current management strategies and short-term outcomes.
DESIGN
Prospective population-based, observational study for 12 months from March 2016.
SETTING
Specialist neonatal surgical units in the UK.
MAIN OUTCOME MEASURES
Incidence of CDO, associated anomalies and short-term outcomes.
RESULTS
In total, 110 cases were identified and data forms were returned for 103 infants giving an estimated incidence of 1.22 cases per 10 000 (95% CI 1.01 to 1.49) live births. Overall, 59% of cases were suspected antenatally and associated anomalies were seen in 69%. Operative repair was carried out mostly by duodenoduodenostomy (76%) followed by duodenojejunostomy (15%). Postoperative feeding practice varied with 42% having a trans-anastomotic tube placed and 88% receiving parenteral nutrition. Re-operation rate related to the initial procedure was 3% within 28 days. Two infants died within 28 days of operation from unrelated causes.
CONCLUSION
This population-based study of CDO has shown that the majority of infants have associated anomalies. There is variation in postoperative feeding strategies which represent opportunities to explore the effects of these on outcome and potentially standardise approach. Short-term outcomes are generally good.
Topics: Duodenal Obstruction; Duodenum; Female; Humans; Infant; Infant, Newborn; Intestinal Atresia; Male; Parenteral Nutrition; Postoperative Care; Reoperation; Severity of Illness Index; United Kingdom
PubMed: 31229958
DOI: 10.1136/archdischild-2019-317085 -
Fetal Diagnosis and Therapy 2020The "double bubble" sign is an ultrasonographic finding that commonly represents duodenal atresia and is associated with trisomy 21.
BACKGROUND
The "double bubble" sign is an ultrasonographic finding that commonly represents duodenal atresia and is associated with trisomy 21.
OBJECTIVES
We sought to evaluate the positive predictive value of a prenatally identified double bubble sign for duodenal atresia and the genetic etiologies associated with it.
METHODS
We examined a retrospective cohort with prenatal double bubble sign between January 1, 2008, and June 30, 2017. Postnatal diagnoses were determined by review of operative reports and additional postnatal evaluation including cytogenetic analysis, molecular analysis, and/or clinical genetic evaluation.
RESULTS
All live births at our institution with a prenatal double bubble sign had confirmed duodenal atresia. Additional anatomic anomalies and/or genetic abnormalities were identified in 62% of cases. Out of 21 cases, 6 had trisomy 21. Of the remaining 15 cases, 8 were nonisolated duodenal atresia, 3 of which had a heterotaxy syndrome. In the 7 isolated cases, 1 likely pathogenic chromosomal microdeletion was identified.
CONCLUSIONS
Prenatal double bubble sign is a reliable predictor of duodenal atresia. In addition to trisomy 21, heterotaxy may be encountered. ZIC3 mutations as well as microdeletion of 4q22.3 may be underlying genetic etiologies to be considered in the diagnostic evaluation of a prenatal double bubble sign.
Topics: Chromosome Deletion; Chromosomes, Human, Pair 4; Down Syndrome; Duodenal Obstruction; Genetic Predisposition to Disease; Gestational Age; Heterotaxy Syndrome; Humans; Intestinal Atresia; Predictive Value of Tests; Retrospective Studies; Risk Factors; Ultrasonography, Prenatal
PubMed: 31167209
DOI: 10.1159/000500471 -
World Journal of Gastroenterology Feb 2015To compare the clinical outcomes of uncovered and covered self-expandable metal stent placements in patients with malignant duodenal obstruction. (Comparative Study)
Comparative Study
AIM
To compare the clinical outcomes of uncovered and covered self-expandable metal stent placements in patients with malignant duodenal obstruction.
METHODS
A total of 67 patients were retrospectively enrolled from January 2003 to June 2013. All patients had symptomatic obstruction characterized by nausea, vomiting, reduced oral intake, and weight loss. The exclusion criteria included asymptomatic duodenal obstruction, perforation or peritonitis, concomitant small bowel obstruction, or duodenal obstruction caused by benign strictures. The technical and clinical success rate, complication rate, and stent patency were compared according to the placement of uncovered (n = 38) or covered (n = 29) stents.
RESULTS
The technical and clinical success rates did not differ between the uncovered and covered stent groups (100% vs 96.6% and 89.5% vs 82.8%). There were no differences in the overall complication rates between the uncovered and covered stent groups (31.6% vs 41.4%). However, stent migration occurred more frequently with covered than uncovered stents [20.7% (6/29) vs 0% (0/38), P < 0.05]. Moreover, the overall cumulative median duration of stent patency was longer in uncovered than in covered stents [251 d (95%CI: 149.8 d-352.2 d) vs 139 d (95%CI: 45.5 d-232.5 d), P < 0.05 by log-rank test] The overall cumulative median survival period was not different between the uncovered stent (70 d) and covered stent groups (60 d).
CONCLUSION
Uncovered stents may be preferable in malignant duodenal obstruction because of their greater resistance to stent migration and longer stent patency than covered stents.
Topics: Adult; Aged; Aged, 80 and over; Duodenal Obstruction; Duodenoscopy; Female; Foreign-Body Migration; Humans; Male; Metals; Middle Aged; Neoplasms; Palliative Care; Prosthesis Design; Retrospective Studies; Stents; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25663777
DOI: 10.3748/wjg.v21.i5.1580 -
BMJ Case Reports Dec 2020An 87-year-old woman presented to us with a 5-day history of worsening epigastric pain and vomiting. Her medical history included known gallstones and a previous episode...
An 87-year-old woman presented to us with a 5-day history of worsening epigastric pain and vomiting. Her medical history included known gallstones and a previous episode of acute cholecystitis complicated by a perforated gallbladder for which she had declined surgery 5 years prior. Radiological imaging confirmed a large gallstone impacted in the first part of the duodenum with gross gastric outlet obstruction and pneumobilia, confirming the diagnosis of Bouveret syndrome, an often overlooked and rare variant of gallstone ileus. Following an unsuccessful oesophagogastroduodenoscopy for stone retrieval, she underwent a laparotomy and gastrotomy with a successful outcome and discharged from hospital 4 weeks following the procedure.
Topics: Aged, 80 and over; Duodenal Obstruction; Duodenum; Endoscopy, Digestive System; Female; Gallbladder; Gallstones; Gastric Outlet Obstruction; Humans; Ileus; Stomach; Syndrome; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography
PubMed: 33370996
DOI: 10.1136/bcr-2020-238620 -
Journal of Medical Case Reports Nov 2023The duodenal web is a thin, elongated, web-like structure that is one of the factors contributing to duodenal obstruction. Only 100 cases have been reported in the...
BACKGROUND
The duodenal web is a thin, elongated, web-like structure that is one of the factors contributing to duodenal obstruction. Only 100 cases have been reported in the literature. We present a 2.5-year-old cachectic Afghan child who did not have any overt signs and symptoms of intestinal obstruction, like recurrent vomiting, abdominal distention, and weight loss. The web was discovered near the intersection of the third and fourth portions, which is an uncommon location for the duodenal web. The late presentation of congenital duodenal web with partial obstruction is rare but well-known and has been reported in this case.
CASE PRESENTATION
A 2.5-year-old cachectic Afghan child who had recurrent vomiting and experienced abdominal distention was brought to Maiwand Teaching Hospital from the Jabelsuraj region of Parwan province. The patient was suffering from unusual signs and symptoms like recurrent vomiting, abdominal distention, weight loss, and constipation. The diagnosis of these anomalies was established by a detailed history, clinical features, and abdominal CT scan. In the computerized tomography scanning (CT-Scan) image reported, there was a web with stenosis and partial obstruction in the distal aspect of the third-to-fourth portion of the duodenum. After preoperative stabilization, the child was taken for surgery. The abdomen was opened by a right upper abdominal transverse incision. After web resection and duodenoplasty, the patient was shifted to the recovery room in satisfactory condition. The child was allowed to feed after 8 days, which he tolerated well.
CONCLUSION
Congenital duodenal web with partial obstruction is typically observed in the second and third years of life. It is suspected in patients with recurrent vomiting, abdominal distention, weight loss, and constipation. Partial obstruction may not have an overt presentation, making it a challenging diagnosis for general practitioners. Abdomen X-ray and CT scan usually confirm the diagnosis, and successful surgical intervention is recommended.
Topics: Male; Humans; Child, Preschool; Duodenum; Duodenal Diseases; Duodenal Obstruction; Constipation; Vomiting; Weight Loss
PubMed: 37996900
DOI: 10.1186/s13256-023-04179-3 -
Journal of the American Veterinary... Sep 2012To characterize duodenal sigmoid flexure volvulus (DSFV) and determine the prognosis for affected cattle undergoing surgery.
OBJECTIVE
To characterize duodenal sigmoid flexure volvulus (DSFV) and determine the prognosis for affected cattle undergoing surgery.
DESIGN
Retrospective case series.
ANIMALS
29 dairy cattle.
PROCEDURES
The medical records were analyzed for history, signalment, clinical signs, medical management, surgical findings, and outcome.
RESULTS
29 cattle were determined to have DSFV between December 2006 and August 2010. Twenty cattle had had an omentopexy or pyloropexy performed 1 day to 2 years before initial evaluation. Cattle were afebrile, tachycardic, and moderately dehydrated, with a small zone of percussion with a ping at the 10th to 12th right intercostal spaces and associated succussion. Biochemical changes were a severe hypokalemic (mean ± SD, 2.9 ± 0.5 mmol/L; median, 3.1 mmol/L; range, 2.08 to 3.92 mmol/L), hypochloremic (mean, 69.7 ± 11.1 mmol/L; median, 71.7 mmol/L; range, 49.1 to 94.1 mmol/L) metabolic alkalosis (mean total CO(2), 44.5 ± 7.4 mmol/L; median, 45.3 mmol/L; range, 31.5 to 59.6 mmol/L) and hyperbilirubinemia (mean, 32.4 ± 29.0 μmol/L; median, 20.5 μmol/L; range, 7.8 to 107 μmol/L). Surgical findings for DSFV included an empty descending duodenum adjacent to a dorsally displaced and dilated cranial segment of the duodenum, distended abomasum and gallbladder, and a tight volvulus at the base of the duodenal sigmoid flexure. Manual reduction was considered successful if the descending duodenum filled after cranial duodenal massage. Twenty-two patients were successfully treated; the remaining 7 died or were euthanized within 4 days after surgery.
CONCLUSIONS AND CLINICAL RELEVANCE
A condition clinically resembling abomasal volvulus but affecting the duodenal sigmoid flexure has been recognized in dairy cattle. When a focal, dorsal right-sided ping and succussion are present combined with severe hypokalemic, hypochloremic metabolic alkalosis and high bilirubin concentration, DSFV should be suspected, especially when there is a history of prior abomasal fixation. After surgical correction, the prognosis is fair to good.
Topics: Animals; Cattle; Cattle Diseases; Duodenal Obstruction; Female; Intestinal Volvulus; Prognosis; Retrospective Studies; Treatment Outcome
PubMed: 22916860
DOI: 10.2460/javma.241.5.621 -
BMC Gastroenterology Jun 2009Malignant gastric outlet obstruction (GOO) is commonly seen in patients with advanced gastric-, pancreatic-, duodenal, hepatobiliary or metastatic malignancies. Ten to... (Review)
Review
BACKGROUND
Malignant gastric outlet obstruction (GOO) is commonly seen in patients with advanced gastric-, pancreatic-, duodenal, hepatobiliary or metastatic malignancies. Ten to 25% of patients with pancreatic cancer will develop duodenal obstruction during the course of the disease. Duodenal stenting with self-expandable metal stents is an alternative treatment to surgical bypass procedures. Our aim was to review the published literature regarding treatment of malignant GOO with stents to reveal whether the information provided is sufficient to evaluate the clinical effects of this treatment
METHODS
A literature search from 2000-2007 was conducted in Pub Med, Embase, and Cochrane library, combining the following search terms: duodenal stent, malignant duodenal obstruction, gastric outlet obstruction, SEMS, and gastroenteroanastomosis. All publications presenting data with > or = 15 patients and only articles written in English were included and a review focusing on the following parameters were conducted: 1) The use of graded scoring systems evaluating clinical success; 2) Assessment of Quality of life (QoL) before and after treatment; 3) Information on stent-patency; 4) The use of objective criteria to evaluate the stent effect.
RESULTS
41 original papers in English were found; no RCT's. 16 out of 41 studies used some sort of graded scoring system. No studies had objectively evaluated QoL before or after stent treatment, using standardized QoL-questionnaires, 32/41 studies reported on stent patency and 9/41 performed an oral contrast examination after stent placement. Objective quantitative tests of gastric emptying had not been performed.
CONCLUSION
Available reports do not provide sufficient relevant information of the clinical outcome of duodenal stenting. In future studies, these relevant issues should be addressed to allow improved evaluation of the effect of stent treatment.
Topics: Duodenal Neoplasms; Duodenal Obstruction; Gastric Outlet Obstruction; Humans; Quality of Life; Stents; Treatment Outcome
PubMed: 19534803
DOI: 10.1186/1471-230X-9-45 -
Acta Bio-medica : Atenei Parmensis Dec 2018Intraoperative endoscopy is a procedure that supports open and laparoscopic surgery, helping the surgeon to identify the presence of endoluminal gastrointestinal lesions... (Review)
Review
INTRODUCTION
Intraoperative endoscopy is a procedure that supports open and laparoscopic surgery, helping the surgeon to identify the presence of endoluminal gastrointestinal lesions which need to be treated, with a correct diagnosis and an adequate therapy.
MATERIAL AND METHODS
A search on PubMed was performed using "intraoperative esophagoscopy", "intraoperative duodenoscopy", and "intraoperative enteroscopy" as Mesh terms. The applied exclusion criteria were: papers written before 2000, not concerning pediatric or gastrointestinal pathology, literature-review articles, language different from English.
RESULTS
Sixteen studies from 2000 to 2018 were included. Overall, 1210 patients were treated. Different pathologies were considered. Complications were observed in a range of 0.3-14%. The most frequent complications were perforation, bleeding and mucosal tear. Mortality ranged between 0.7% and 1,2%.
CONCLUSION
Intraoperative endoscopy is an indispensable tool for gastrointestinal surgery. In the hands of experienced endoscopists, intraoperative endoscopy can be performed safely, in time-efficient manner, facilitating diagnosis and treatment.
Topics: Adolescent; Child; Colonoscopy; Digestive System Diseases; Duodenal Obstruction; Endoscopy, Digestive System; Esophageal Achalasia; Gastroesophageal Reflux; Gastrointestinal Hemorrhage; Humans; Intraoperative Care; Intraoperative Complications; Peutz-Jeghers Syndrome
PubMed: 30561422
DOI: 10.23750/abm.v89i8-S.7890