In most patients with obstructive duodenal disease, surgical removal of the dilated loops of small intestine leads to resolution of symptoms. In the remainder, palliative therapy (e.g., parenteral nutrition or medications) must be employed.
Duodenal obstruction is associated with a variety of causes, including malignancy and congenital abnormalities. Duodenal obstruction may, therefore, present with a wide variety of causes. For patients with suspected duodenal obstruction, a thorough comprehensive medical workup is warranted.
DUOD obstruction is a rare and infrequent disease with most patients presenting late, resulting in poor outcome. It is a cause of severe vomiting and abdominal/chest pain. DUOD may be the second most common cause of small bowel obstruction (SBO), following post bowel surgery ileus. Duodenal obstruction is an indication of the need for surgical exploration. It is important to perform prompt diagnosis and treatment. Surgical treatment of the duodenal obstruction should include the resection and reconstruction of the duodenum.
About 500 people will be diagnosed with duodenal obstruction in the United States per year. As surgeons and gastroenterologists become more aware of this condition, their referral rates will decrease.
We believe that we present proof that laparoscopic duodenal atresia repair is safe and effective in selected patients. This type of operation has to be proposed as the gold standard, but future multicenter randomized prospective studies are warranted.
Gastroesophageal reflux disease is a relatively common diagnosis among patients with duodenal obstruction. Genetic loci with major diagnostic significance, including loci outside major reflux-related genes, were identified as new genetic loci for duodenal obstruction.
The medical community should be aware of the [poor outcomes associated with surgical management of duodenal obstruction]. A prospective clinical trial of surgery for duodenal obstruction is reasonable. However, patients should be informed that the likelihood of survival is poor for individuals with duodenal obstruction, even for those who receive surgery in a reasonable survival time and only with surgery-related complications. The need for a prospective trial remains undefined.
There have been many advances in the management of duodenal obstruction in the past century. Nevertheless, there are still many problems to be solved. One of them is how to reduce the incidence of choledochal cysts. It will be necessary to explore more approaches to treat them. Nevertheless, other technical problems in the management of duodenal obstruction will be required in the future.
Although recent investigations do not reveal a definitive etiology, they are useful to identify the key characteristics in the development of the intestinal obstruction in patients with duodenal obstruction.
There is an increased risk of complications, including anastomotic leakage and wound infection, in the subset of patients who require conversion from an open technique. These patients should be carefully considered for early surgical intervention and close monitoring.