Duodenal Atresia- Clinical Presentation and Management in Tertiary Care Centre
Authors: Khare Atul 
Published: July 2024

Introduction: Congenital duodenal obstruction (CDO) is a common surgical anomaly in newborns, that can be diagnosed prenatally and requires careful planning for surgical repair after birth. This study focuses on the surgical management of duodenal atresia. Intestinal atresia is one of the most common and leading causes of neonatal intestinal obstruction (NIO), and second most common cause of NIO in many developing countries. In this study, we analysed the short term outcome of surgical management of intestinal atresia in our unit. Aims and objectives: This prospective and retrospective cohort study done in one-year period from march 2021 to march 2022 in a tertiary care hospital in Indian population [ mainly west India]. The main aim of our study is- ‘’Duodenal atresia- clinical presentation and management in tertiary care centre’’. Materials and methods: All patients of intestinal atresia admitted in our centre in neonatal unit in one-year period from march 2021 to march 2022 were included, the data recorded and analysed. Data of demographics, antenatal history, presentation, location, and type of IA (duodenal, jejuno-ileal, colonic), and peri-operative complications were recorded. After making our presumptive diagnosis with clinical assessment, an upright X-ray abdomen was taken and Decision for surgery was finalised. Statistical Package for Social Sciences (SPSS 15.0 version, SPSS Inc, Chicago Ill) was used for data entry and analysis. Results were expressed as means, ranges and percentages. Results: 64 patients were male and 48 of them were female, M:F ratio was 1.3:1. Average weight of atresia was 2.14 kg [ranges from 1.1- 3.3kg] and mean age of presentation was 6.54 days [ranges from one day to 32 days]. Patients having age more than one week were only 28 [25%] in number. Cases were highest in December and lowest in the month of April. Muslim population were mostly associated with duodenal atresia. Intestinal atresia included different variants as follows, duodenal atresia- [n=44], Jejuno-ileal- [n=60], Colonic- [n=4], Multiple atresia- [n=4]. In duodenal atresia the distribution was as follows, DA- type-1 [n=14] in which annular pancreas [n=6] and perforated duodenal web [n=4], DA- type-2 [n=2] and DA-type-3 [n=28] cases. In duodenal atresia, TEF associated with [n=3], ARM associated with [n=3] and ARM with TEF both associated with [n=2] cases. In jejunoileal atresia type-1 [n=10], Type-2 [n=5], Type-3a [n=36], Type-3b [n=1], Type-4 [n=12] were recorded. In colonic atresia type-1 [n=3], type-2 [n=0] and type-3 [n=1] cases were recorded. In DA vomiting was the chief complaint while in JIA and IA abdominal distension, bilious vomiting and failure to pass meconium were the chief complains. All patients required surgical repair. A surprising result was found in jejunal atresia patients treated with tapering enteroplasty with trans-anastomotic tube with 100% survival rates. Most common complication was functional obstruction followed by SSI and anastomotic leak. Most of the patients required reoperation in JIA cases. Return of bowel function was seen in 4.3 days in DA, 6.2 days in JIA and 8.4 days in colonic atresia. Mean hospital stay for DA was noted to be 11.4 days, for jejunal atresia it was around 12.8 days and for CA it was found to be 11.5 days for survivors. Overall survival rates of surgery of intestinal atresia after surgery was 51.8%, among which DA accounted to 59.1%, jejuno-ileal atresia- 50% and for CA- 50%. During the one month follow up period, mainly cough and cold n=7 [6.25%], fever n=5 [4.46%], functional obstruction n=2 [1.78%] and with sepsis in n=1 [0.9%] were found. Conclusions: Short term survival of neonates with intestinal atresias in our unit is still poor when compared with statistics from developed countries. Thus efforts are being made to improve the surgical outcome and to understand difficulties faced by surgeons with the help of this study.