**8. Postoperative complications**

Early complications: By far, the most common complication in the early postoperative period is feeding intolerance. Typically, gastrointestinal function may take days to weeks following repair of duodenal atresia. A contrast upper gastrointestinal series should be performed if feeding is not started by week 3 postoperatively to assess the anastomosis for stricture and gastric and duodenal emptying. The dilated preatretic

#### *Congenital Duodenal Obstruction: Atresia, Stenosis, and Annular Pancreas DOI: http://dx.doi.org/10.5772/intechopen.111385*

duodenum will likely persist for months. The decision for another surgical intervention should be carefully considered depending on the clinical and radiological data. Surgical interventions could either be in the form of reperforming the anastomosis for stricture formation or tapering duodenoplasty for a mega-duodenum that failed to properly empty [11, 43]. Other common causes of reoperation are anastomotic leak, adhesive bowel obstruction, or concomitant gastrointestinal malformation not detected in the initial operation, such as malrotation or duodenal web [40, 44]. Literature on management of anastomotic leak following duodenal atresia repair is scarce and that is likely due to the rarity of such complication. The presence of systemic signs of sepsis, significant abdominal tenderness, or abdominal wall erythema should alert the surgeon to the possibility of anastomotic leak. Significant pneumoperitoneum on plain abdominal radiographs is usually sufficient to make the diagnosis, however, contrast upper gastrointestinal series may also be required. Urgent reoperation is highly recommended with attempt to assess the cause of the anastomotic leak. Repair is done with either adding more sutures to reinforce the anastomosis or re-doing the entire anastomosis particularly if there is a major dehiscence or a problem of the duodenal orientation. Placement of a closed suction drain in area is important in such scenario. The incidence of reoperation following the initial repair is approximately 14% [40].

The late complications that are peculiar to duodenal atresia patients include megaduodenum and blind loop syndrome. Both can present with feeding intolerance, bilious vomiting, diarrhoea, poor weight gain, recurrent abdominal pain, or bile reflux gastritis. Food or foreign body impaction can present at any age where obstruction occurs at the site of anastomosis. Upper gastrointestinal endoscopy is often helpful in assessing the duodenum and perhaps dilation if a stricture is found. Tapering duodenoplasty may be required in carefully selected groups of patients [11, 43, 45].
