Congenital duodenal diaphragm in eight children

Results Of the 22 children with congenital duodenal obstruction (CDO), 8 (36.4%), 4 males and 4 females, had CDD (Table 1). All had a full-term normal vaginal delivery except one who had 30 weeks gestation. All presented with bile-stained vomiting. Six were newborns and all except one did not pass meconium. The one who passed meconium was found to have a CDO secondary to a diaphragm with a central hole. Three were jaundiced and three had upper abdominal distension. Three were dehydrated and one (patient No. 5, Table 1) had Klebsiella septicemia at the time of presentation, which necessitated treatment with antibiotics for 8 days prior to surgery. In all children, the diagnosis was made from plain abdominal Xray, which showed the classic double-bubble appearance, and barium meal, which showed duodenal obstruction. In three children, the obstruction was complete (Figure 1), while in the other five the obstruction was incomplete, with gas present distally in the rest of the bowel and streaks of contrast material passed into the intestines (Figure 2). Four (50%) of our patients had associated anomalies, as shown in Table 1. Two (25%) had Down’s syndrome. A B From the *Department of Obstetrics and Gynaecology and **Department of Pathology, Aga Khan University Hospital Karachi, Pakistan.