Congenital Duodenal Stenosis in a Patient Diagnosed as Having Multiple Stenoses During Laparoscopic Surgery

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  • 腹腔鏡手術中に多発狭窄と診断し得た先天性十二指腸狭窄症の1例
  • 症例報告 腹腔鏡手術中に多発狭窄と診断し得た先天性十二指腸狭窄症の1例
  • ショウレイ ホウコク フククウキョウ シュジュツ チュウ ニ タハツ キョウサク ト シンダン シエタ センテンセイ ジュウニシチョウ キョウサクショウ ノ 1レイ

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Abstract

<p>The patient was an 11-day-old girl born at 39 weeks and 1 day of gestation, weighing 2,918 g, and without any abnormal findings during fetal growth. She initially showed poor feeding and poor weight gain, followed by bilious vomiting 10 days after birth. She was referred to our department for detailed examination and treatment 11 days after birth. Congenital duodenal stenosis (the initial finding) was diagnosed on the basis of chest and abdominal plain X-ray findings and upper gastrointestinal series, and laparoscopic surgery was performed. A diameter difference of the intestine was observed in the descending part of the duodenum, and a transverse incision was made slightly towards the oral side. However, insertion of an 8-Fr Nelaton catheter (NC) was not possible from either the oral or anal side of the incision. No air flow in the incision was seen when air was introduced through a nasogastric tube. Another transverse incision was made to the enlarged portion of the oral side of the duodenum, and patency to the oral side was confirmed. A 2-cm vertical incision was made in the horizontal part of the duodenum, which was sufficiently mobilized, and patency to the anal side was confirmed by introducing air through an NC placed via the vertical incision. These findings indicated two stenoses. The oral side was reconstructed with a diamond-shaped anastomosis, formed by the quadrilateral resection of the intestinal wall contralateral to the mesentery to connect the two transverse incisions. In this patient, we demonstrated that the presence of multiple stenoses should be examined not only during laparotomy, but also during laparoscopic surgery. Our findings suggest that air flow through the NC, which was used in the present case, is an effective method of examining the presence of any other stenosis.</p>

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