Duodenal atresia and stenosis: long-term follow-up over 30 years.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Escobar
Mauricio A
MA
Section of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Ladd
Alan P
AP
Grosfeld
Jay L
JL
West
Karen W
KW
Rescorla
Frederick J
FJ
Scherer
L R
LR
Engum
Scott A
SA
Rouse
Thomas M
TM
Billmire
Deborah F
DF
D000015:Abnormalities, Multiple / Q000401:mortality; D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic; D004314:Down Syndrome / Q000150:complications; D004378:Duodenal Diseases / Q000453:epidemiology / Q000601:surgery; D004380:Duodenal Obstruction / Q000151:congenital* / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D004381:Duodenal Ulcer / Q000209:etiology; D004385:Duodenostomy; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery; D006330:Heart Defects, Congenital / Q000401:mortality; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007409:Intestinal Atresia / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D007416:Intestinal Perforation / Q000453:epidemiology / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies