Öz
Amaç: Yenidoğan dönemindeki intestinal obstruksiyonların çoğunluğunu konjenital duodenal obstrüksiyonlar oluşturur. Preoperatif ve postoperatif yenidoğan yoğun bakım uygulamaları ve uygun nutrisyonel tedaviler sayesinde morbidite ve mortalite önemli derecede azalmasına rağmen, literatürde duodenal obstrüksiyonlara zaman içerisinde yapılan müdahaleleri kıyaslayan çalışmaların yapılmadığı görülmektedir. Çalışmamızda, kliniğimizdeki konjenital duodenal obstruksiyonlu olguların klinik bilgilerini, literatürde sunulan klinik bilgiler ile karşılaştırarak, konjenital duodenal obstruksiyonların tedavisinin zaman içindeki sürecini incelemeyi amaçladık.
Gereç ve Yöntemler: 2006-2016 yıllarında kliniğimizde tedavi edilen konjenital duodenal obstruksiyon tanılı 16 olgu gestasyonel yaşı, cinsiyeti, doğum ağrılığı, başvuru günü, şikayeti, ek anomalileri, ameliyat zamanı, yapılan ameliyat, beslenme zamanı, yatış süresi ve takip açısından retrospektif olarak incelenip literatürdeki benzer çalışmalar ile karşılaştırılarak, günümüzdeki konjenital duodenal obstruksiyonların tedavisinin durumu tartışılmıştır.
Bulgular: Dokuz olgu erkek, 7 olgu kız olmak üzere, %69 olgu prematüreydi. Ortalama gestasyonel yaş 34.8 (29-40) haftaydı. Klinik şikayetler 11 olguda kusma, 4 olguda batın distansiyonu ve bir olguda ise genel durum bozukluğutu. Konjenital kalp hastalığı sekiz olguda, Down Sendromu beş olguda ve iki olguda malrotasyon tespit edildi. Cerrahi yöntem olarak en sık olarak 12 olguya Diamond-Shape duodenoduodenostomi uygulandı. Ortalama total parental nutrisyon (TPN) alma süresi 8.4 gün ve ortalama yatış süreleri 17.56 gündü. Olguların tümünde cerrahi komplikasyon görülmeyerek, tam iyileşme ile taburcu edildi.
Sonuç: Literatür değerlendirmemizde cerrahi süreçlerin kesitsel olarak verildiği ancak hastalığın bütünsel incelemesinin daha az yapıldığını görüldü. Yapılan karşılaştırmalarda, zaman içerisinde mortalitenin anlamlı şekilde azalma gösterdiği ancak cerrahi tekniklerde ve beslenmeye başlama günü ortalamalarında değişme olmadığı görüldü. Dikkat çekici olarak, sepsis oranlarında artış gözlendi. Literatürdeki olguların çoğunluğunun prematür bebekler olması, hastanede uzun kalış süreleri ve bu olguların göreceli olarak düşük immünitelerinin olması, sepsis oranlarındaki artışı açıklayabilir. Bu durumda, servis şartlarının daha iyi belirlenmesi ve postoperatif enteral ve parenteral beslenme ile mortalite ve morbidite arasında daha detaylı korelasyon çalışmalarının yapılması gerektiğini önermekteyiz.
Anahtar Kelimeler
Kaynakça
- 1- Girvan DP, Stephens CA. Congenital intrinsic duodenal obstruction: a twenty-year review of its surgical management and consequences. J Pediatr Surg 1974; 9: 833-39.
- 2- Wayne ER, Burrington JD. Management of 97 children with duodenal obstruction. Arch Surg 1973; 107: 857-60.
- 3- Ladd WE. Congenital duodenal obstruction. Surgery 1937; 1: 878-85.
- 4- Tandler J. Zur entwicklunggeschicte des menschlichen duo- denums. Morphol Jb 1902; 29: 187-216.
- 5- Schnaufer L. Duodenal atresia, stenosis and annular pancreas. In: Welch KJ, Randolph JG, Ravitch MM (Eds). Pediatric Surgery. Vol 2, 4th ed. Chicago, IL, Year Book 1986; 929-37.
- 6- Potts SR, Garstin WI. Neonatal duodenal obstruction with emphasis on cases with Down's syndrome. Ulster Med J. 1986 Oct;55(2):147-50.
- 7-Mustafawi AR1, Hassan ME. Congenital duodenal obstruction in children: a decade's experience. Eur J Pediatr Surg. 2008 Apr;18(2):93-7. doi: 10.1055/s-2008-1038478.
- 8-Rattan KN, Singh J, Dalal P. Neonatal Duodenal Obstruction: A 15-Year Experience. J Neonatal Surg. 2016 Apr 10;5(2):13. eCollection 2016 Apr-Jun.
- 9- Sherif N Kaddah, Khaled HK Bahaa-Aldin, Hisham Fayad Aly, Hosam Samir Hassan. Congenital Duodenal Obstruction. Annals of Pediatric Surgery, Vol 2, No 2, April 2006, PP 130-135
- 10- Chen QJ1, Gao ZG, Tou JF, Qian YZ, Li MJ, Xiong QX, Shu Q. Congenital duodenal obstruction in neonates: a decade's experience from one center. World J Pediatr. 2014 Aug;10(3):238-44. doi: 10.1007/s12519-014-0499-4.
- 11- Tsai LY1, Hsieh WS, Chen CY, Chou HC, Tsao PN, Hsu WM. Distinct clinical characteristics of patients with congenital duodenal obstruction in a medical center in Taiwan.Pediatr Neonatol. 2010 Dec;51(6):343-6. doi: 10.1016/S1875-9572(10)60066-6.
- 12- Bailey PV1, Tracy TF Jr, Connors RH, Mooney DP, Lewis JE, Weber TR. Congenital duodenal obstruction: a 32-year review. J Pediatr Surg. 1993 Jan;28(1):92-5.
- 13- Yadav, K.Neonatal Duodenal Obstruction. American Journal of Gastroenterology . May1979, Vol. 71 Issue 5, p485-489. 5p. 7 Charts.
- 14- Stauffer UG, Schwoebel M. Duodenal atresia and stenosis- annular pancreas. In: O'Neill JA, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG (Eds). Pediatric Surgery, Vol 2, 5th ed. Philadelphia, Mosby Year Book 1998; 1133-43.
- 15-Kim JY1, You JY1, Chang KH1, Choi SJ1, Oh SY2, Seo JM3, Roh CR1, Kim JH1. Association Between Prenatal Sonographic Findings of Duodenal Obstruction and Adverse Outcomes. J Ultrasound Med. 2016 Sep;35(9):1931-8. doi: 10.7863/ultra.15.09074. Epub 2016 Jul 27.
- 16- Adzick NS, Harrison MR, deLorimier AA. Tapering duodenoplasty for megaduodenum associated with duodenal atresia. J Pediatr Surg. 1986; 21:311-2.
- 17- Hayden CK, Schwartz MZ, Davis M, Swischuk LE. Combined esophageal and duodenal atresia: sonographic findings. Am J Radiol 1983; 140: 225-26.
- 18- M. Bishay, B. Lakshminarayanan, A. Arnaud, M. Garriboli, K. M. Cross, J. I. Curry et al. The role of parenteral nutrition following surgery for duodenal atresia or stenosis . Pediatric Surgery International February 2013, Volume 29, Issue 2, pp 191–195
Öz
Objective: Congenital duodenal obstructions consitute the majority of intestinal obstructions in the neonatal period. Although, morbidity and mortality have decreased significantly with preoperative and postoperative neonatal intensive care and appropriate nutritional therapies, it is seen that there are no studies comparing the interventions in duodenal obstructions over time. In our study, we aimed to examine the process of treatment of congenital duodenal obstruction over time by comparing the clinical datas of cases with congenital duodenal obstruction in our clinic with the clinical information presented in the literature .
Material and Methods: Sixteen cases with congenital duodenal obstruction treated in our clinic between 2006-2016 were retrospectively reviewed for gestational age, gender, birth pain, application day, complaint, additional anomalies, operation time, surgery, feeding time, length of stay and follow-up. The current status of congenital duodenal obstruction therapy is discussed.
Results: Nine boy, 7 girl cases, %69 of cases were premature. The mean gestational age was 34.8 (29-40) weeks. Clinical complaints were vomiting in 11 cases, abdominal distension in 4 cases, and general condition disorder in one case. Eight cases had congenital heart disease, five cases had Down’s syndrome and two cases had malrotation. Diamond-Shape Duodenoduodenostomy was performed in 12 cases as the most common surgical method. The mean total parenteral nutrition (TPN) period was 8.4 days and mean hospitalization time was 17.56 days. All patients were discharged with full recovery without any surgical complication.
Conclusion: In literature review, it was seen that surgical processes were given cross-sectional but detailed examinations of the disease were less. In the comparisons, it was seen that the mortality decreased significantly over time but there was no change in the mean of surgical techniques and mean of starting day to feeding.
Remarkably, an increase in sepsis rates was observed. The majority of cases in the literature are prematurity cases, long hospital stays and relatively low immunities of these cases may explain the increase in sepsis rates. In this situation, we suggest that determinate the better service conditions and more detailed correlation studies should be performed between postoperative enteral and parenteral nutrition and mortality and morbidity.
Anahtar Kelimeler
Kaynakça
- 1- Girvan DP, Stephens CA. Congenital intrinsic duodenal obstruction: a twenty-year review of its surgical management and consequences. J Pediatr Surg 1974; 9: 833-39.
- 2- Wayne ER, Burrington JD. Management of 97 children with duodenal obstruction. Arch Surg 1973; 107: 857-60.
- 3- Ladd WE. Congenital duodenal obstruction. Surgery 1937; 1: 878-85.
- 4- Tandler J. Zur entwicklunggeschicte des menschlichen duo- denums. Morphol Jb 1902; 29: 187-216.
- 5- Schnaufer L. Duodenal atresia, stenosis and annular pancreas. In: Welch KJ, Randolph JG, Ravitch MM (Eds). Pediatric Surgery. Vol 2, 4th ed. Chicago, IL, Year Book 1986; 929-37.
- 6- Potts SR, Garstin WI. Neonatal duodenal obstruction with emphasis on cases with Down's syndrome. Ulster Med J. 1986 Oct;55(2):147-50.
- 7-Mustafawi AR1, Hassan ME. Congenital duodenal obstruction in children: a decade's experience. Eur J Pediatr Surg. 2008 Apr;18(2):93-7. doi: 10.1055/s-2008-1038478.
- 8-Rattan KN, Singh J, Dalal P. Neonatal Duodenal Obstruction: A 15-Year Experience. J Neonatal Surg. 2016 Apr 10;5(2):13. eCollection 2016 Apr-Jun.
- 9- Sherif N Kaddah, Khaled HK Bahaa-Aldin, Hisham Fayad Aly, Hosam Samir Hassan. Congenital Duodenal Obstruction. Annals of Pediatric Surgery, Vol 2, No 2, April 2006, PP 130-135
- 10- Chen QJ1, Gao ZG, Tou JF, Qian YZ, Li MJ, Xiong QX, Shu Q. Congenital duodenal obstruction in neonates: a decade's experience from one center. World J Pediatr. 2014 Aug;10(3):238-44. doi: 10.1007/s12519-014-0499-4.
- 11- Tsai LY1, Hsieh WS, Chen CY, Chou HC, Tsao PN, Hsu WM. Distinct clinical characteristics of patients with congenital duodenal obstruction in a medical center in Taiwan.Pediatr Neonatol. 2010 Dec;51(6):343-6. doi: 10.1016/S1875-9572(10)60066-6.
- 12- Bailey PV1, Tracy TF Jr, Connors RH, Mooney DP, Lewis JE, Weber TR. Congenital duodenal obstruction: a 32-year review. J Pediatr Surg. 1993 Jan;28(1):92-5.
- 13- Yadav, K.Neonatal Duodenal Obstruction. American Journal of Gastroenterology . May1979, Vol. 71 Issue 5, p485-489. 5p. 7 Charts.
- 14- Stauffer UG, Schwoebel M. Duodenal atresia and stenosis- annular pancreas. In: O'Neill JA, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG (Eds). Pediatric Surgery, Vol 2, 5th ed. Philadelphia, Mosby Year Book 1998; 1133-43.
- 15-Kim JY1, You JY1, Chang KH1, Choi SJ1, Oh SY2, Seo JM3, Roh CR1, Kim JH1. Association Between Prenatal Sonographic Findings of Duodenal Obstruction and Adverse Outcomes. J Ultrasound Med. 2016 Sep;35(9):1931-8. doi: 10.7863/ultra.15.09074. Epub 2016 Jul 27.
- 16- Adzick NS, Harrison MR, deLorimier AA. Tapering duodenoplasty for megaduodenum associated with duodenal atresia. J Pediatr Surg. 1986; 21:311-2.
- 17- Hayden CK, Schwartz MZ, Davis M, Swischuk LE. Combined esophageal and duodenal atresia: sonographic findings. Am J Radiol 1983; 140: 225-26.
- 18- M. Bishay, B. Lakshminarayanan, A. Arnaud, M. Garriboli, K. M. Cross, J. I. Curry et al. The role of parenteral nutrition following surgery for duodenal atresia or stenosis . Pediatric Surgery International February 2013, Volume 29, Issue 2, pp 191–195
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Cerrahi |
| Bölüm | ORIGINAL ARTICLES |
| Yazarlar | |
| Yayımlanma Tarihi | 22 Ocak 2021 |
| Gönderilme Tarihi | 18 Temmuz 2019 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 15 Sayı: 1 |