Key Words: duodenal obstruction, fenestrated duodenal membrane, congenital duodenal stenosis
Abstract
Duodenal atresia is the third cause of intrinsic intestinal obstruction in the neonatal period. Typical presentation includes early-onset vomiting of gastric or bilious content, abdominal distension and poor weight gain. If the obstruction is incomplete, as in a perforated duodenal diaphragm, presenting symptoms tend to appear later and be nonspecific, so diagnosis is usually delayed. We present the case of a 9-year-old girl with a history of biliary postprandial vomiting from the infancy period, without any impact on the nutritional status, managed symptomatically. At two years of age, an upper digestive endoscopy was performed, which was frustrated by an abundance of gastric contents. She is again studied at nine years of age with contrasting upper digestive tract and upper digestive endoscopy, which suggest the diagnosis of fenestrated duodenal membrane. Duodeno-jejunum anastomosis is performed in Roux-en-Y, with a good postoperative outcome.
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La atresia duodenal corresponde a la tercera causa de obstrucción intestinal intrínseca en período neonatal. El cuadro típico corresponde a vómitos de contenido gástrico o bilioso, de inicio temprano, distensión abdominal y mal incremento ponderal. En caso de que la obstrucción sea incompleta, como ocurre con el diafragma duodenal perforado, las manifestaciones suelen ser más tardías e inespecíficas, por lo que el diagnóstico suele retrasarse. Se presenta el caso de una escolar de nueve años, con antecedente de vómitos postprandiales biliosos desde el período de lactante, sin repercusión en estado nutricional, manejada sintomáticamente. Previamente, se realizó estudio a los dos años con endoscopía digestiva alta, la cual resultó frustra por abundante contenido gástrico. Se estudia nuevamente a los nueve años de edad con tránsito digestivo superior contrastado y endoscopía digestiva alta, los que sugieren el diagnóstico de membrana duodenal fenestrada. Se realiza duodeno-yeyuno anastomosis en Y de Roux, evolucionando favorablemente.
Autores:
Andrea Barrueto Barrera[1], Sofia Santelices Baeza[1], Francisco Miranda Labra [1], David Schnettler Rodríguez[1,2]
Affiliation:
[1] Facultad de Medicina, Universidad Católica del Maule, Región del Maule, Chile
[2] Servicio de Cirugía infantil, Hospital Doctor Cesar Garavagno Burotto, Región del Maule, Chile
E-mail: aracelybarrueto.b@gmail.com
Author address:
[1] Calle Doce y Media Norte 5 Oriente 47
Villa Prosperidad
Talca
Región del Maule
Chile
Citation: Barrueto Barrera A, Santelices Baeza S, Miranda Labra F, Schnettler Rodríguez D. Duodenal diaphragm diagnosis in a school-aged child and minimally invasive treatment: case report. Medwave 2017 Ene-Feb;17(1):e6859 doi: 10.5867/medwave.2017.01.6859
Submission date: 18/11/2016
Acceptance date: 11/1/2017
Publication date: 31/12/1969
Origin: no solicitado
Type of review: con revisión por dos pares revisores externos, a doble ciego
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- Asabe K, Oka Y, Hoshino S, Tsutsumi M, Yokoyama M, Yukitake K, et al. Modification of the endoscopic management of congenital duodenal stenosis. Turk J Pediatr. 2008 Mar-Apr;50(2):182-5. | PubMed |
- Keckler SJ, St Peter SD, Spilde TL, Ostlie DJ, Snyder CL. The influence of trisomy 21 on the incidence and severity of congenital heart defects in patients with duodenal atresia. Pediatr Surg Int. 2008 Aug;24(8):921-3. | CrossRef | PubMed |
- Mousavi SA, Karami H, Saneian H. Congenital duodenal obstruction with delayed presentation: seven years of experience. Arch Med Sci. 2016 Oct 1;12(5):1023-1027. | PubMed |
- Rattan KN, Singh J, Dalal P. Neonatal Duodenal Obstruction: A 15-Year Experience. J Neonatal Surg. 2016 Apr 10;5(2):13. | PubMed |
- Perales Córdoba JN, Paulín CosíoE. Membrana duodenal congénita en el adulto. Cirujano General. 2001 Jul;23(3):189-193. | Link |
- Lee SS, Hwang ST, Jang NG, Tchah H, Choi DY, Kim HY, et al. A case of congenital duodenal web causing duodenal stenosis in a down syndrome child: endoscopic resection with an insulated-tip knife. Gut Liver. 2011 Mar;5(1):105-9. | CrossRef | PubMed |
- Rodriguez-Garcia R, Rodriguez-Garcia FC. Diagnóstico prenatal de atresia intestinal múltiple. Rev Mex Ped. 2005 Jul; 72(4):179-81. | Link |
- Cano Muñoz I, Montoya Mendoza N. Obstrucción duodenal en pacientes pediátricos. Ann Radiol Méx. 2011;4:258-273. | Link |
- Javier Sánchez-Nava J, Jiménez-Urueta PS, Mejía-Sánchez M, Sánchez-Torres R, Sánchez-Michaca VJ, Aguilar-Aguirre JM. Membrana duodenal fenestrada en un neonato de muy bajo peso. Acta Pediatr Mex. 2010;31(3):129-132. | Link |
Asabe K, Oka Y, Hoshino S, Tsutsumi M, Yokoyama M, Yukitake K, et al. Modification of the endoscopic management of congenital duodenal stenosis. Turk J Pediatr. 2008 Mar-Apr;50(2):182-5. | PubMed |Keckler SJ, St Peter SD, Spilde TL, Ostlie DJ, Snyder CL. The influence of trisomy 21 on the incidence and severity of congenital heart defects in patients with duodenal atresia. Pediatr Surg Int. 2008 Aug;24(8):921-3. | CrossRef | PubMed |Mousavi SA, Karami H, Saneian H. Congenital duodenal obstruction with delayed presentation: seven years of experience. Arch Med Sci. 2016 Oct 1;12(5):1023-1027. | PubMed |Rattan KN, Singh J, Dalal P. Neonatal Duodenal Obstruction: A 15-Year Experience. J Neonatal Surg. 2016 Apr 10;5(2):13. | PubMed |Perales Córdoba JN, Paulín CosíoE. Membrana duodenal congénita en el adulto. Cirujano General. 2001 Jul;23(3):189-193. | Link |Lee SS, Hwang ST, Jang NG, Tchah H, Choi DY, Kim HY, et al. A case of congenital duodenal web causing duodenal stenosis in a down syndrome child: endoscopic resection with an insulated-tip knife. Gut Liver. 2011 Mar;5(1):105-9. | CrossRef | PubMed |Rodriguez-Garcia R, Rodriguez-Garcia FC. Diagnóstico prenatal de atresia intestinal múltiple. Rev Mex Ped. 2005 Jul; 72(4):179-81. | Link |Cano Muñoz I, Montoya Mendoza N. Obstrucción duodenal en pacientes pediátricos. Ann Radiol Méx. 2011;4:258-273. | Link |Javier Sánchez-Nava J, Jiménez-Urueta PS, Mejía-Sánchez M, Sánchez-Torres R, Sánchez-Michaca VJ, Aguilar-Aguirre JM. Membrana duodenal fenestrada en un neonato de muy bajo peso. Acta Pediatr Mex. 2010;31(3):129-132. | Link |
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