Dear colleagues,

Does somebody have an experience with patient with isolated duodenum.

In our department we have a patient in whom already prenataly cystic mass in the abdominal cavity was diagnosed.Postnataly in the 1st day of life he was tranfered to our department with exteremly enlarged abdomen, no vomiting. In laparotomy megaduodenum with duodenal atresia was diagnosed, stomack was absolutaly normal. There was isolated megaduodenum. Duodenojejunostomy was performed. In histology - nerve cells and fibres are present in the wall of dilated megaduodenum, fibrotic tissue in submucosa is seen. Transfer through anastomosis was not observed although 4,8 mm endoscope freely entered the anastomosis. In order to provide the patient enteral feeding jejunostomy was performed. Acholic stool appeared. Discharege from nasoduodenal tube - with bile around 120-160 ml/day. Third laparotomy was performed - duodeno-jejunal anastomosis was re-made, jejunal tube was put through nose (naso-jejunal). After this third operation - still acholic stool, large amount of discharge with bile from nasoduodenal tube. In contrast X ray - no passage through the anastomosis, endoscopy - 4,8 mm endoscope enters the anastomosis without problems.

What could be the tactic and managemnt of this patient?

Thank you all in advance!

Zane Abola

Pediatric Surgeon