To investigate the diagnosis of pediatric spherical duodenal disease, pathogenesis and choice of surgical methods. Methods:Upper gastrointestinal angiography to observe duodenal dilatation and peristalsis;Observation of postoperative clinical manifestations of different surgical modalities. Conclusion:Clinical efficacy:Gastrojejunostomy + spherical duodenum tubuloplastySimple gastrojejunostomyGastrojejunostomy + pyloric dissection. Pediatric congenital spherical duodenal disease, also known as megaduodenal disease, is a kind of gastrointestinal spherical malformation, which is rare and easy to be misdiagnosed and mistreated. It is easy to misdiagnose and mismanage the disease, and the surgical treatment is not standardized, so it is difficult to achieve a radical cure. Since 1990, our hospital has admitted 5 cases of this disease, and the knitting situation is summarized as follows. 1.Clinical data Among the 5 cases in this paper, there were 3 males and 2 females, aged 4-12 years old, with an average of 7±2 years old. At the time of consultation, they complained of vomiting, epigastric fullness, large amount of vomiting with bile, and sometimes the children used the knee-chest position or emetic methods to alleviate the symptoms. Medical treatment (including the application of gastric motivation drugs) was ineffective, and the symptoms gradually worsened. All five cases were diagnosed by upper gastrointestinal imaging. The contrast showed obvious duodenal dilatation, 2 cases of extreme duodenal dilatation, spherical changes, a large amount of barium stagnation in the duodenum, fluoroscopic observation of the duodenum without obvious peristalsis and retrograde peristalsis, 5 cases of patients according to the duodenal obstruction of cesarean section, the duodenum was seen in the operation extreme dilatation, the volume is about 300-2000 milliliters, there is no stenosis in the distal end of the dilatation, the diaphragm and the external compression, the entire The duodenum was quiescent, and no obvious peristalsis or antiperistalsis could be observed. Two cases were treated with duodenal coxal resection and molding + gastrojejunal anastomosis; two cases were treated with simple gastrojejunal anastomosis; and one case was treated with pyloric dissection + duodenal absenteeism + gastrojejunal anastomosis. Whole layer biopsy of the lesion site, pathology showed that the smooth muscle of the intestinal wall was obviously thinned, muscle fiber degeneration and atrophy, and the number of intermuscular and submucosal ganglion cells was obviously reduced. Recent outcome: 5 patients had no serious postoperative complications during hospitalization, and still had different degrees of abdominal distension, but it was reduced compared with the preoperative period. Vomiting was still present, but the amount and frequency of vomiting were reduced compared with the preoperative period. Long-term outcome: all cases were obtained and followed up for 3-5 years. For those who underwent pyloric dissection + gastrojejunostomy, postoperative vomiting was reduced, but the reduction of abdominal distension was not obvious and tended to worsen further. For those who only underwent gastrojejunostomy, abdominal distension and vomiting disappeared in 2 cases after surgery, and the other 2 cases still had vomiting and abdominal distension, but they were significantly reduced compared with the preoperative period. In all cases, the upper gastrointestinal imaging review, barium barium from the gastrojejunal anastomosis into the small intestine, barium barium into the duodenum is still downstream jejunum, and then returned to the stomach through the pylorus and then through the gastrojejunal anastomosis downstream. 2, Discussion 2.1 Pathogenesis and diagnostic points: in general, the expansion of the local digestive tract obstruction should be able to observe a clear mechanical obstruction factors in its distal end, common causes are: duodenal loop pancreas, diaphragm, superior mesenteric artery compression syndrome, intestinal rotation malrotation, etc., and obstruction of the above expansion of the intestinal segments, there should be a mechanical obstruction of the clinical manifestations. However, intraoperative exploration of this syndrome can not be clear obstruction factors, and the dilated duodenum is in a passive dilatation of the tension-free state, can not be observed strong peristalsis and reverse peristalsis. The downward movement of the digestive tract content mainly relies on the peristalsis of the intestinal wall muscles, while the duodenal segment is in a state of muscle weakness caused by certain factors, so that the content of the digestive tract is stagnant and passively dilated here. 2.2 Selection of surgical modalities, the diagnosis of the surgical condition is difficult to determine and there is no fixed surgical modality, in this paper, three modalities are used to treat this condition. Simple gastroduodenal anastomosis can make the stomach content directly into the small intestine, and duodenal stagnation can be regurgitated into the stomach through the pylorus, which can reduce duodenal distension, the operation of this procedure is relatively simple, and the therapeutic effect is still acceptable. It can be used in primary hospitals. Pyloric dissection + duodenal absent + gastrojejunal anastomosis, can only solve the food downstream into the small intestine, but the duodenum still produces a large amount of bile, pancreatic fluid retention, downstream difficulties, and can not be regurgitated into the stomach through the pylorus, the therapeutic effect is poor, it is not suitable for use; duodenal molding + gastrojejunal anastomosis, theoretically superior to the above two modalities, but the duodenal tubular molding surgery is very traumatic, postoperative morbidities, and the patient However, duodenoplasty is very traumatic, has many postoperative complications, and is not tolerated by the patient; intraoperative decision should be made according to the condition of the patient.