Duodenal atresia and stenosis is a frequent cause of congenital, intestinal obstruction.
Current operative techniques and contemporary neonatal critical care result in a 5%
morbidity and mortality rate, with late complications not uncommon, but unknown to
short-term follow-up.
A retrospective review of patients with duodenal anomalies was performed from 1972
to 2001 at a tertiary, children's hospital to identify late morbidity and mortality.
Duodenal atresia or stenosis was identified in 169 patients. Twenty children required
additional abdominal operations after their initial repair with average follow-up
of 6 years (range, 1 month to 18 years) including fundoplication (13), operation for
complicated peptic ulcer disease (4), and adhesiolysis (4). Sixteen children underwent
revision of their initial repair: tapering duodenoplasty or duodenal plication (7),
conversion of duodenojejunostomy to duodenoduodenostomy (3), redo duodenojejunostomy
(3), redo duodenoduodenostomy (2), and conversion of gastrojejunostomy to duodenoduodenostomy
(1). There were 10 late deaths (range, 3 months to 14 years) attributable to complex
cardiac malformations (5), central nervous system bleeding (1), pneumonia (1), anastomotic
leak (1), and multisystem organ failure (2).
Late complications occur in 12% of patients with congenital duodenal anomalies, and
the associated late mortality rate is 6%, which is low but not negligible. Follow-up
of these patients into adulthood is recommended to identify and address these late
occurrences.