The late nonfunctioning duodenal atresia repair--a second look.
OBJECTIVE
In 1986, the authors reported on 3 newborns who had repair of their duodenal atresia, and between 6 and 18 months postoperatively an anastomotic obstruction developed in each suddenly. After prolonged medical and surgical treatments it became apparent that the duodenal atresia repair was functionally obstructed and plication of the dilated atonic proximal duodenum was curative. Since then, 2 more patients became so obstructed at 5 and 24 years postoperatively. The aim of this study was to report the very late occurrence of a functional obstruction of a newborn duodenal atresia repair.


METHODS
The 2 additional histories and surgical repairs were reviewed.


RESULTS
The 5-year old boy was cured immediately with plication only of his dilated proximal duodenum. The 24-year-old nurse had a very stormy 2-year course with several bypass operations, which did not relieve her abdominal pain and bile vomiting until they were taken down and her dilated proximal duodenum was plicated, after which she made a good recovery. Both remain well.


CONCLUSIONS
An uncommon, very late, sudden, apparently anastomotic, postoperative, newborn, duodenal atresia repair obstruction caused by proximal, dilated, duodenal atony, and dysfunction can occur many years later and responds to duodenal plication alone.
Ein
S H
SH
Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
Kim
P C
PC
Miller
H A
HA
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D004378:Duodenal Diseases / Q000209:etiology / Q000601:surgery*; D004386:Duodenum / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D012086:Reoperation; D016896:Treatment Outcome