Duodenal Obstruction

Duodenal obstruction results from duodenal atresia, web, stenosis, annular pancreas, or malrotation. It usually presents in newborns as feeding intolerance and stomach distension. Bilious emesis is seen if the obstruction is distal to the ampulla of Vater, which is the case in the vast majority of cases. One-third of patients will also have Down's syndrome. Diagnosis is confirmed with air contrast upper GI with findings of a "Double-Bubble". Initial treatment is NG tube decompression and IVF hydration. Operative treatment is dependent upon the cause of the obstruction but should be pursued rapidly if malrotation is the suspected cause. The most commonly employed surgical therapy is duodenoduodenostomy. However, duodenal webs may be treated with duodenotomy and excision. An annular pancreas should never be divided.

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