Congenital duodenal disorders in children

Abstract

Background. Congenital duodenal disorders are relatively common diseases for children. There are 1: 500; 1: 1000 cases of live newborns. They represent a congenital defect of rotation and fixation of the duodenum produced at the moment of rotation of the primitive intestine. The most common pathology is diagnosed in older children or adults. Most of these disorders do not have a clear etiology and pathogenesis. The lack of specific clinical signs and symptoms at early clinical-evolutionary stages presents a difficulty in establishing a diagnosis. Treatment is controversial, especially for congenital forms. Evolutionarily the first signs are repeated vomiting, abdominal pain conditioned by the evacuatory disorders of the stomach and duodenum as a result of arterio-mesenteric compression of the duodenum, duodenal-jejunangle and other inflammatory processes that deform both the duodenum and the jejunum. The most informative diagnostic method is standard abdominal radiography supplemented by contrast radiography, followed by abdominal ultrasound, digestive tract scintigraphy, MRI. Case report. We present the case of a patient operated for duodenum malformation. Patient 7 years old, male hospitalized urgently in the emergency surgery department, presented with diffuse abdominal pain, repeated vomiting with food + ball content. According to the information given by mother, the baby is practically sick from birth. The patient repeatedly was treated at the gastrologist but without improvement of the general condition. The objective examination shows that the abdomen is painful to palpate in the epigastric region, but without muscular defense. Ultrasound-moderate abdominal meteorism. The abdominal x-ray shows the hydroaerial levels in the stomach, the left flank. Hematology shows slight anemia, leukocytes 8000, without other biochemical changes. At endoscopic examination (FEGDS), there was total duodenal-gastro-esophageal reflux, gastroduodenitis. Gastrointestinal transit with contrast substance: macrogastria, slowed discharge from the stomach at 30 minutes, 3 and 9 hours. With the diagnosis of duodenal malrotation, the patient underwent surgical treatment. Intraoperative, multiple embryonic brides have been diagnosed, in which is Ladd, Jakson, common mesh. The operative and postoperative period without any particularities, without any secondary modifications. Conclusions. In duodenal disorders, surgical treatment must be supplemented by the complex drug, including anti-adherence to eliminate inflammatory processes and intestinal occlusive complications.