Tapering duodenoplasty and gastrojejunostomy in the management of children with megaduodenum

Objective To explore the management strategies of idiopathic megaduodenum among children.Methods For 4 cases of megaduodenum at our hospital from 2005 to 2011,the clinical features,radiological data,treatment options,pathological findings and prognosis were retrospectively analyzed.And the relevant literatures were reviewed.Results The diagnosis of non-obstructive megaduodenum was confirmed by upper gastro-intestinal contrast study,ultrasonography and exploratory laparotomy.Cases 1 and 2 underwent tapering duodenoplasty with a proximal stump of duodenum divided & closed at pylorus and a Roux-en-Y gastrojejunostomy.And cases 3 and 4 had tapering duodenoplasty with proximal stump closure and an end-to-side gastrojejunostomy.On pathological examinations,all neural and vascular structures appeared normal.During the follow-up,diarrhea,bloating,vomiting and nausea disappeared and there was a rapid postoperative gain of body weight.Conclusions Idiopathic megaduodenum without organic obstruction is a rare clinical pediatric condition.Massive duodenal dilatation may be visualized distinctly by upper gastro-intestinal contrast study and antenatal ultrasonography.And satisfactory outcomes can be achieved by tapering duodenoplasty with proximal stump closure and gastrojejunostomy of either Roux-en-Y or end-to-side anastomosis. Key words: Megaduodenum;  Child;  Anastomosis,Roux-en-Y