Saline-aided ultrasound as a primary investigation tool in diagnosis of duodenal obstruction in preterm infants

Abstract

Background: Congenital duodenal obstruction (CDO) is among the most prevalent causes of neonatal intestine blockage, with an incidence reported as 1 in 2,500 to 10,000 live births.
Objective: To evaluate the role of ultrasound (US) with saline infusion in detection of duodenal atresia in preterm infants. Patients and Methods: This prospective cross-sectional study included 50 preterm neonates, aged 1 to 35 days, of both sexes, at the incubation and had repeated bilious vomiting. The neonates underwent saline-aided US and were evaluated using intraoperative findings as the reference standard. US features, such as the double bubble sign, hyperechogenic band, and duodenal web, were assessed.
Results: The saline-aided US accurately diagnosed duodenal obstruction in 41 (82%) neonates, with a double bubble sign observed in all cases. The causes of obstruction included annular pancreas (AP) (34%), duodenal atresia (8%), duodenal web (30%), and duodenal malrotation (28%). For detecting AP, the hyperechogenic band had a sensitivity of 76.5%, specificity of 100%, and accuracy of 92% (AUC=0.882), with a perfect agreement (P < 0.001, Kappa = 0.811) between two sonographers. US and surgery had moderate agreement for duodenal atresia detection but perfect agreement for duodenal web and malrotation, with 100% accuracy for both.
Conclusions: Saline-aided US is an effective, radiation-free primary diagnostic tool for detecting duodenal obstruction in preterm infants, offering high diagnostic accuracy and excellent agreement with surgical findings.