SUBTOTAL DUODENECTOMY WITH JEJUNAL PATCH FOR MEGADUODENUM SECONDARY TO CONGENITAL DUODENAL MALFORMATION

Background/Purpose: This report describes a technique devised for two children with megaduodenum consisting of subtotal duodenal resection w ith the proximal jejunum used as an onlay patch. Methods: A a-year-old boy presented after unsuccessful surgical repairs for duodenal stenos is with web. Another 8-year-old boy returned from the United States af ter several surgical procedures for complicated congenital left diaphr agmatic hernia with gastric outlet obstruction. Both boys manifested p ostprandial right upper abdominal fullness, occasional vomiting, abdom inal pain, and failure to thrive. Upper gastrointestinal contrast stud y findings showed massively dilated duodenums in both patients that we re larger than the stomach. During the operative procedures, about 95% of the duodenal wall was resected, leaving the basal portion that was unified with the pancreatic head and the ampulla of Vater as linguifo rm flap, which was covered with the proximal jejunum as an onlay patch so as to form the anterior wall of the duodenal bulb. Results: The pa tients showed markedly improved quality of life and catch-up growth af ter the operations. The duodenal bulbs were of adequate size in follow -up gastrointestinal series. Conclusion: This technique will be useful in cases of functional duodenal obstruction with megaduodenum seconda ry to congenital duodenal malformations leading to blind loop syndrome . Copyright (C) 1998 by W.B. Saunders Company.