Delayed presentation of a congenital duodenal web managed successfully with incision of web

Abstract

One of the causes of congenital incomplete duodenal obstruction is the presence of congenital duodenal web with fenestration. This condition requires a high index of suspicion for an early and accurate diagnosis. We present an unusual presentation of duodenal web in a 6-year-old girl who presented with a 3-year history of cyclical and seasonal vomiting and abdominal pain. The diagnosis of congenital duodenal web with fenestration was made on contrast study and endoscopy and was treated surgically by incision of the web.

Surgical management of duodenal web in an adult presenting with melaena; Case report and literature review

“…Varied operative techniques have been described for the management of duodenal web, including gastrojejunostomy, duodenojejunostomy, and duodenotomy with web excision [1] , [3] , [5] , [6] , [10] . Authors in the last decade concur that a longitudinal incision, excision of the web and transverse closure of the duodenotomy is the optimal optimal approach [1] , [4] , [5] , [7] , [11] , [12] . In appropriate patients, minimally invasive techniques may avoid the need for laparotomy or duodenotomy, which can also result in complications [13] .…”

“…Patients typically present with postprandial upper abdominal pain, nausea and abdominal distension [3] . There is a strong association between duodenal web and other congenital abnormalities, such as Trisomy 21, annular pancreas, congenital heart disease and developmental delay [3] , [4] , [5] , [6] . Duodenal web is rarely diagnosed in adults, and may occur secondary to pancreatitis, ulceration, obstruction, non-steroidal anti-inflammatory drugs (NSAIDs) or abdominal surgery [1] , [7] .…”

Distal duodenal web with malrotation: An unusual finding

“…8 Some cases are reported to have been successfully managed endoscopically. 9 Dilation with the balloon is preferred as incising the web can damage the ampulla. 9 However, the major limitation is the non-availability of the facility, as well as inexperience of the endoscopist.…”

An Unusual Diagnosis for an Infant Presenting with Olive-Shaped Abdominal Mass

“…Congenital duodenal web (CDW) is a rare cause of intestinal obstruction with an incidence of 1 in 10,000 to 1 in 40,000 live births. Duodenal web (type I duodenal atresia) occurs due to failure of recanalization of the duodenal lumen during the 8 th to 10th week of gestation [ 5 ] The web comprised a thin layer of mucosa and submucosa only with absent muscularis, and it tends to cause the classical windsock deformity of the duodenal lumen on upper gastrointestinal contrast study [ 6 ].…”

“…The vomiting in CDW may be bilious or nonbilious, depending on the level of obstruction. Bile-stained vomitus occurs in two-thirds of the cases of CDW that are distal to the ampulla of Vater[ 6 , 8 ].…”