Subtotal duodenal resection with tapering duodenoplasty, duodenojejunostomy, and feeding jejunostomy for blind pouch syndrome following congenital duodenal diaphragm repair: a report of two cases

Blind pouch syndrome is a rare late complication following surgery for congenital duodenal diaphragm. Progressive duodenal dilatation and intestinal stasis may result in recurrent vomiting, abdominal distension, feeding intolerance, and malnutrition. We report two paediatric cases managed with a comprehensive strategy incorporating preoperative nutritional prehabilitation, reconstructive surgery, and early postoperative enteral nutrition (EN). Two patients with blind pouch syndrome were retrospectively reviewed between May 2022 and April 2024. Upper gastrointestinal contrast studies demonstrated markedly dilated blind-pouch segments, and gastroscopy was performed to confirm the anatomical abnormality and facilitate placement of nasojejunal feeding tubes. The patients underwent preoperative nutritional prehabilitation with combined EN and parenteral nutrition (PN) for 20 and 14 days, respectively. Definitive surgery consisted of subtotal duodenal resection with tapering of the dilated duodenum, end-to-end duodenojejunostomy, and feeding jejunostomy. Both procedures were completed without major perioperative complications. Postoperative management included gastrointestinal decompression, early enteral feeding through the jejunostomy, and supplemental PN. Jejunostomy feeding was initiated on postoperative day (POD) 1. Oral feeding commenced on POD 23 and POD 20, and PN was discontinued on POD 45 and POD 30, respectively. The jejunostomy tubes were removed on POD 60 and POD 45. During follow-up periods of 3 years for Case 1 and 1.5 years for Case 2, vomiting and abdominal distension resolved, oral feeding tolerance improved, and weight-for-age and height-for-age Z-scores increased. Follow-up upper gastrointestinal contrast studies demonstrated unobstructed passage and improved duodenal morphology. In these two cases, a tailored strategy combining preoperative nutritional support, subtotal duodenal resection with tapering, end-to-end duodenojejunostomy, and feeding jejunostomy was technically feasible and was associated with favourable clinical and nutritional outcomes. Given the very small sample size, these findings should be interpreted cautiously and cannot establish the comparative safety or efficacy of this approach. Larger studies are needed to further evaluate its role in the management of postoperative duodenal blind pouch syndrome.