Food Refusal as an Unusual Presentation in a Toddler With Duodenal Web

Abstract

Duodenal web most commonly presents with a history of vomiting and failure to thrive in the early infancy period. This study reports on a child who had an initial presentation of feeding intolerance and rare nonbilious emesis. The unusual presentation of food refusal directed the investigation to an upper endoscopy to look for evidence of gastrointestinal mucosal disease such as gastroesophageal reflux disease, peptic ulcer disease, Helicobacter pylori infection, and food allergy including celiac disease. The finding of duodenal web with a central aperture was unexpected but explains the mild degree of her gastrointestinal symptoms.

Resection of a duodenal web using single-incision pediatric endosurgery

“…The web can either be located in the pre-or postpapillar duodenum, clinically leading to nonbilious or bilious emesis, respectively [6]. Most commonly, the web leads to repetitive vomiting and failure to thrive in early infancy, although late presentations such as in our case have been described [7]. The combination of Down syndrome, duodenal stenosis, and gastric pneumatosis has also been reported previously [8].…”

Vomiting and food refusal causing failure to thrive in a 2 year old: an unusual and late manifestation of congenital duodenal web

“…Late and unusual manifestations of duodenal web have been reported before in case reports at ages 5, 6, 8 and 19 months 1 10–12. Very rarely congenital duodenal webs have been known to present for the first time in adults 13 14…”

The Uncommon Diagnosis of Windsock Deformity for a Common Presentation

“…A windsock deformity is usually an isolated anomaly, most frequently located between the first and second part of the duodenum in 85%-90% of cases 1,3 . Only 10% of cases were combined with congenital disorders such as Down's syndrome, Situs Inversus, congenital heart disease, annular pancreas or intestinal malrotation 4,5 . Such pathology presenting beyond the age of infancy has rarely been reported 6 .…”

“…This study is diagnostic when the barium retention is noted for at least 6 hours 3 . Other imagings such as abdominal ultrasound and flexible upper gastrointestinal endoscopy have been used as a diagnostic tools 4 . Antenatal, small bowel gas observed distal to a 'double bubble,' would raise the suspicion of duodenal stenosis, web or malrotation with midgut volvulus 2 .…”

“…The majority of cases are asymptomatic. The symptoms include nausea, vomiting, abdominal pain and weight loss; however, it is noteworthy to mention that the deformity has caused recurrent pancreatitis and gastrointestinal bleeding in some patients 3,4 . The pain could be in the epigastric, rightupper or in umbilical area and is worsened by eating; vomiting or certain postures could bring relief 3 .…”