Congenital membranous stenoses of the duodenum and their importance in adults

Abstract

Membranous stenoses of the duodenum are also observed in the adult and are often treated incorrectly because they are falsely diagnosed (ulcer, eholecystopathy etc.). The diagnosis is made roentgenologically. Bordering elastic membranes seldom cause complaints. If the opening is small, they sometimes form intraluminal blind pouches (sac-like structures), the so-called intraduodenal diverticula under pressure of the ingested foodstuff. Up to the present time 26 such "diverticula" have been reported, of which 17 were surgically removed. The principle clinical symptoms include stenosis, bleeding and unspecific upper abdominal complaints. In two of the cases, the radiologieally diagnosed blind pouch could not be confirmed at the time of the laparotomy. Seven of the patients underwent conservative treatment. The pathogenesis of the so-called intraduodenal diverticula is discussed from personal roentgencinematographic experience as follows: detailed histological examinations of various parts of the septal wall show, that the results of a membranous stenosis are determined by the fine tissue structure of the membrane itself. The membrane which forms the pseudodiverticulum consists of collagenous and abundant fibrous connective tissue. A submucosa and the fibrous layer of a muscularis mucosae are present, on the other hand the true muscularis of the intestinal wall is absent. In addition to these observations, a further impressive radiological case can be presented, which has not yet been published. Key-Words:Congenital duodenal stenosis --Membranous duodenal stenosis --Intraduodenal diverticulum. Die angeborene Duodenalstenose ist ein seltenes, aber wohlbekanntes I4rankheitsbild, dessen Diagnose und Behandlung im Neugeborenenund Kleinkindesalter kaum Schwierigkeiten bereitet. Beim Erwachsenen 20 Langenbecks Arch. Chir., Bd. 326 O + o = n~ © © = ©