Tapering duodenoplasty and gastrojejunostomy in the management of idiopathic megaduodenum in children

Abstract

Purpose: The purpose of this study is to present the management of idiopathic megaduodenum in children.

Methods: A retrospective analysis of 4 cases of megaduodenum admitted from 2005 to 2011 was performed evaluating clinical features, radiologic data, treatment, pathologic findings, and prognosis. The corresponding literature was reviewed.

Results: The diagnosis of nonobstructive megaduodenum was confirmed by upper gastrointestinal contrast study, ultrasonography, and exploratory laparotomy. Treatment consisted of either tapering duodenoplasty with pylorus division and closure of the proximal stump plus Roux-en-Y gastrojejunostomy or tapering duodenoplasty with closure of the proximal stump and end-to-side gastrojejunostomy. On pathologic evaluation, neural and vascular structures appeared normal in all sections. All symptoms, including diarrhea, bloating, vomiting, and nausea, had resolved on follow-up, and all patients experienced rapid weight gain after their operation.

Conclusions: Idiopathic megaduodenum without organic obstruction is a rare clinical condition. Massive dilatation confined to the duodenum was shown by upper gastrointestinal contrast studies and ultrasonography and can also be identified on antenatal ultrasonography. In children with megaduodenum, satisfactory results can be obtained by tapering duodenoplasty with proximal stump closure and gastrojejunostomy with either Roux-en-Y or end-to-side anastomosis.