Volume 5, Issue 1 (2020)
SJMR 2020, 5(1): 48-53 |
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Seyedi S J, Seyedi S A, Samet M A, Mortazavi S M, Nateghi M R, Sanaye Naderi M. A rare case of duodenal atresia with severe gastric bleeding, treated by vagotomy. SJMR 2020; 5 (1) :48-53
URL: http://saremjrm.com/article-1-193-en.html
URL: http://saremjrm.com/article-1-193-en.html
Seyed Javad Seyedi * 
1, Seyed Arsalan Seyedi2 , Mohammad Amin Samet2 , Seyed Mazyar Mortazavi2 , Mohammad Reza Nateghi3 
, Maryam Sanaye Naderi3
1, Seyed Arsalan Seyedi2 , Mohammad Amin Samet2 , Seyed Mazyar Mortazavi2 , Mohammad Reza Nateghi3 , Maryam Sanaye Naderi3
1- Sarem Fertility and Infertility Research Center (SAFIR), Sarem Women’s Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran. , dr.SEYYEDI@sarem.org
2- Sarem Fertility and Infertility Research Center (SAFIR), Sarem Women’s Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.
3- Sarem Fertility & Infertility Research Center (SAFIR) & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.
2- Sarem Fertility and Infertility Research Center (SAFIR), Sarem Women’s Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.
3- Sarem Fertility & Infertility Research Center (SAFIR) & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.
Abstract: (3812 Views)
Introduction: Embryonic development of the gastrointestinal tract is a very complex process and therefore the number of congenital malformations of the fetus is reported to be numerous and varied. The most common site for atresia, after the esophagus, is the duodenum. Duodenal atresia is the congenital absence or complete blockage of a part of the duodenal lumen. This atresia is seen in perinatal examinations as polyhydramnios in pregnancy ultrasounds. Early detection of intestinal obstruction is essential to prevent further complications.
Patient Information: The present study is a case report of a 34-week-old preterm infant weighing 1980g, resulting from cesarean delivery with Apgar 8 and 9, who was diagnosed as duodenal atresia in prenatal examinations. The patient was a candidate for surgery on the day after birth, who suffered from severe gastric bleeding on the same day and was rushed to the operating room. In the operating room, due to severe bleeding and hypotension, with great effort by the anesthesiologist, the infant was intubated and subsequently, the infant underwent gastrotomy and blood clots were removed. There was oozing of blood from the mucosal surface. Then, duodenodenodenostomy surgery was performed, which continued after bleeding into the stomach, so in these conditions, several solutions such as total gastrectomy, pacing, and vagotomy were proposed. The infant underwent anterior-posterior truncal vagotomy. Gastric bleeding was controlled immediately after vagotomy. Because vagotomy can cause the pyloric constriction, gastrojejunostomy is also performed on the baby. The infant was discharged in good general condition without any complications after spending time in the neonatal intensive care unit.
Conclusion: Severe gastrointestinal bleeding is a very rare occurrence in duodenal atresia. In this situation, a gastrectomy can be considered and performed, which will be associated with many problems in the future. In adults, a vagotomy with a vascular contraction mechanism is used to control gastric bleeding. However, no case has been reported in the control of gastrointestinal bleeding in infants. In this case, for the first time, neonatal vagotomy was performed despite special technical subtleties, which was also accompanied by excellent therapeutic results.
Patient Information: The present study is a case report of a 34-week-old preterm infant weighing 1980g, resulting from cesarean delivery with Apgar 8 and 9, who was diagnosed as duodenal atresia in prenatal examinations. The patient was a candidate for surgery on the day after birth, who suffered from severe gastric bleeding on the same day and was rushed to the operating room. In the operating room, due to severe bleeding and hypotension, with great effort by the anesthesiologist, the infant was intubated and subsequently, the infant underwent gastrotomy and blood clots were removed. There was oozing of blood from the mucosal surface. Then, duodenodenodenostomy surgery was performed, which continued after bleeding into the stomach, so in these conditions, several solutions such as total gastrectomy, pacing, and vagotomy were proposed. The infant underwent anterior-posterior truncal vagotomy. Gastric bleeding was controlled immediately after vagotomy. Because vagotomy can cause the pyloric constriction, gastrojejunostomy is also performed on the baby. The infant was discharged in good general condition without any complications after spending time in the neonatal intensive care unit.
Conclusion: Severe gastrointestinal bleeding is a very rare occurrence in duodenal atresia. In this situation, a gastrectomy can be considered and performed, which will be associated with many problems in the future. In adults, a vagotomy with a vascular contraction mechanism is used to control gastric bleeding. However, no case has been reported in the control of gastrointestinal bleeding in infants. In this case, for the first time, neonatal vagotomy was performed despite special technical subtleties, which was also accompanied by excellent therapeutic results.
Keywords: Fetal Gastrointestinal Anomalies, Duodenal Atresia, Duodenal Stenosis, Vagotomy, Duodenoduodenostomy, Case Report
Article Type: Case Report |
Subject:
Pregnancy Care
Received: 2021/02/23 | Accepted: 2021/03/4 | Published: 2021/03/4
Received: 2021/02/23 | Accepted: 2021/03/4 | Published: 2021/03/4
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