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Surgery - management of Duodenal Obstruction in the neonate

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Overview

Duodenal obstruction is a complete or partial blockage of the duodenum. The obstruction can occur at any level in the duodenum, but most occur at the Ampulla of Vater, the entrance from the stomach into the duodenum. Atresia is a complete blockage, stenosis is a partial blockage. Rarely an annular pancreas is found, with the pancreas surrounding the second part of the duodenum causing the obstruction. It can be associated with other congenital anomalies.

Preoperative care of Infants with Duodenal Obstruction

Follow the steps below to ensure safety of baby is maintained pre-operatively.

  1. Follow standard steps for preoperative care.
  2. A large bore orogastric or nasogastric tube is aspirated 6 hourly (aspirates are replaced with 0.9% NaCl and 10mmol KCl/500ml intravenously as prescribed). 
  3. Accurate measurement and recording of urine output, 6 hourly totals and urinalysis 12 hourly. 
  4. The baby remains nil by mouth.

Postoperative care of Infants with Duodenal Obstruction

Follow the steps below to ensure safety of baby is maintained post-operatively.

  1. Follow standard steps for postoperative care.
  2. Ensure the baby is nil by mouth (oral feeds are usually commenced one week post-operatively on the surgeon's orders). 
  3. Ensure a large bore orogastric or nasogastric tube is on free drainage 4-6 hourly aspirates replaced with 0.9% NaCl plus 10mmol KCl/500ml intravenously as prescribed. 
  4. Observe abdominal wound for redness and swelling. Aseptic technique is used for changing abdominal dressing daily. 
  5. Remove abdominal dressing (Tegaderm) as per surgeon's orders. 
  6. Sutures removed on surgeon's orders

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Document Control

  • Date last published: 05 April 2005
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years