Paediatric Surgery (Ukraine). 2024. 3(84): 64-72. doi: 10.15574/PS.2024.3(84).6472
Sliepov O. K., Kotsovsky V. V., Ponomarenko O. P.
Center for neonatal surgery for malformations and their rehabilitation of SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of the NAMS of Ukraine», Kyiv

For citation: Sliepov OK, Kotsovsky VV, Ponomarenko OP. (2024). Surgical treatment of megaduodenum in children who underwent correction of duodenal atresia in the neonatal period. Paediatric Surgery (Ukraine). 3(84): 64-72. doi: 10.15574/PS.2024.3(84).6472.
Article received: Jun 05, 2024. Accepted for publication: Sep 09, 2024.

Aim – to determine the tactics of diagnosis and surgical correction of megaduodenum and its complications in children operated on in the neonatal period for duodenal atresia.
Materials and methods. A retrospective analysis of the medical records of 5 patients with megaduodenum who were treated at the SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of the NAMS of Ukraine» was performed for the period from 2018 to 2023. In the neonatal period, these children were operated on for duodenal atresia at their place of residence (n=3) or at the Institute (n=2).
Results. The diagnosis of megaduodenum was confirmed in 100% of cases. All patients underwent surgery. Stapled longitudinal constrictive duodenoplasty was performed. Intraoperatively, the anatomy of the megaduodenum was examined in detail: its diameter ranged from 42 mm to 90 mm, on average 63.4±21.16 mm, length from 50 mm to 140 mm, on average 98±37.01 mm. In all cases, the patency of the previous duodeno-duodenal anastomosis was monitored. Its diameter ranged from 18 mm to 30 mm. The effect of the surgical treatment in all patients was good.
Conclusions. The developed diagnostic algorithm includes: radiography of the abdominal cavity, X-ray contrast study of the gastrointestinal tract, ultrasound of the ENT organs, EGD, and others if necessary.
Surgical correction of megaduodenum and its complications consists of stapled longitudinal narrowing duodenoplasty, which, in combination with conservative treatment methods, leads to good functional results.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the women was obtained for the research.
The authors declare no conflict of interest.
Keywords: megaduodenum, stapled longitudinal stricture plastic surgery, atresia, dilated duodenum, children.

REFERENCES

1. Alexander F, Difiore J, Stallion A. (2002, Jun). Triangular tapered duodenoplasty for the treatment of congenital duodenal obstruction. J Pediatr Surg. 37(6): 862-864. https://doi.org/10.1053/jpsu.2002.32888; PMid:12037750

2. Baeza-Herrera C, Salinas-Montes J, Salinas-Montes G, Montero-Uscanga CA, López-Castellanos J. (2009). Congenital duodenal obstruction: comparison of two corrective methods. Rev Gastroenterol Mex. 74(1): 1-5. PMID: 19666312.

3. Endo M, Ukiyama E, Yokoyama J, Kitajima M. (1998, Nov). Subtotal duodenectomy with jejunal patch for megaduodenum secondary to congenital duodenal malformation. J Pediatr Surg. 33(11): 1636-1640. https://doi.org/10.1016/S0022-3468(98)90597-8; PMid:9856883

4. Marco Continente C, Fernández Balaguer P, Hernández Sánchez A, López Farias A, Nieto Soler AA. A strange congenital disease, familial megaduodenus: review of the literature. Rev Esp Enferm Dig. 2024 Mar;116(3):163-164. https://doi.org/10.17235/reed.2023.9614/2023; PMid:37073712

5. Qu Z, Zheng B, Ju C, Liu J, Liu B, Zhang H. (2021, Jan 5). Case Report: A Child With Functional Chronic Duodenal Obstruction Caused by Megaduodenum. Front Pediatr. 8: 585699. https://doi.org/10.3389/fped.2020.585699; PMid:33469521 PMCid:PMC7813810

6. Russ A, Chin AC, Terry NE, Abramson LP, Pillai S. (2008, Aug). Presentation and management of late-onset duodenomegaly in a teenager with chronic obstruction from malrotation. J Pediatr Surg. 43(8): e21-24. https://doi.org/10.1016/j.jpedsurg.2008.03.070; PMid:18675621

7. Sliepov OK, Myhur MIu. (2021). Khirurhiia pryrodzhenoi neprokhidnosti tonkoi kyshky u novonarodzhenykh ditei. Monohrafiia. Kyiv: TOV "Vydavnytstvo "BARMY": 256.

8. Zeng K, Li D, Zhang Y, Cao C, Bai R, Yang Z, Chen L. (2021, May 11). Prenatal diagnosis of megaduodenum using ultrasound: a case report. BMC Pregnancy Childbirth. 21(1): 370. https://doi.org/10.1186/s12884-021-03843-0; PMid:33975544 PMCid:PMC8111774

9. Zhang XW, Abudoureyimu A, Zhang TC, Zhao JR, Fu LB, Lin F et al. (2012, May). Tapering duodenoplasty and gastrojejunostomy in the management of idiopathic megaduodenum in children. J Pediatr Surg. 47(5): 1038-1042. https://doi.org/10.1016/j.jpedsurg.2012.02.008; PMid:22595598

10. Wang D, Zhibo Zhang, Yuzuo Bai. (2022). Large abdominal cyst of the fetus: A rare diagnosis of neonatal megaduodenum. Journal of Pediatric Surgery Case Reports. 81. https://doi.org/10.1016/j.epsc.2022.102243