Two cases of duodenal obstruction due to a congenital web

Abstract

with abdominal distention and vomiting. He had tolerated only milk and fluids since birth. The parents were children of first-degree relatives and had six living children. Two brothers of the case died immediately after birth and one sister died at an age of eight months, of unknown causes.On physical examination, epigastric distention was present, but no mass or organomegaly was palpated. Abdominal X-ray on admission showed a dilated stomach (Figure 1). An upper gastrointestinal contrast study demonstrated an axial rotation appearance of the stomach. The transition time of small intestine content was evaluated as normal.At laparotomy, the stomach was significantly dilated and the pylorus seemed to be completely erased at the junction. The wall thicknesses of the duodenum at the first and second parts were increased and similar to the thickness of the antral wall. The jejunoileal walls were thinner than normal and were empty at the distal end. Attempts were made to pass a nasogastric catheter to the jejunum, but the catheter could not go beyond the fourth part of the duodenum. Normal saline, given from the nasogastric catheter, could not pass freely to the distal end, and caused distention of the proximal duodenum. A longitudinal incision was made from the antimesenteric border at the transitional zone. A web, which caused an obstruction just before the Treitz ligament, was observed. In the centre of the web was a hole with a diameter of about 3-4 mm. The web was excised circumferentially. The vertical incision was closed. The nasogastric catheter was taken out on the seventh postoperative day. Abdominal X-rays at early and late postoperative days were normal. A contrast study in the fourth week after the operation revealed a normal duodenal appearance. Case 2A 5 mo-old girl presented to the same institution with abdominal distention and bilious vomiting, mostly seen after meals, for three months. At physical examination, she had mild epigastric distention. There was no mass or organomegaly in the abdomen on palpation. Hematologic parameters and biochemical laboratory findings were normal.An upper gastrointestinal contrast study pre-operatively showed a dilated stomach. The duodenum was dilated in the first and second parts, but the third part was narrow (Figure 2). Abdominal ultrasonography revealed a normal liver size with a hyperechogenic lesion of 30 mm × 25 mm × 20 mm in size, compatible with hemangioma at the caudate lobe.At laparotomy the duodenum was dilated and the wall CASE REPORT Two cases of duodenal obstruction due to a congenital web AbstractWe present two cases of windsock deformity; both were rare in location and one had a rare associated anomaly. In the first case, the windsock was observed in the fourth part of duodenum, causing partial intestinal obstruction. In the second case, the windsock was located in the third part of the duodenum.

Congenital duodenal obstruction: causes and imaging approach

“…A small fenestration can present as a neonatal partial duodenal obstruction [4,32,33]. Larger, less obstructing fenestrations present later in childhood with nonspecific abdominal distension, vomiting or failure to thrive [32,34,35]. The web is almost always attached to the wall of the 2nd portion of the duodenum near the ampulla of Vater [32][33][34], but webs in the 3rd and 4th portions of the duodenum have been described [35].…”

“…Larger, less obstructing fenestrations present later in childhood with nonspecific abdominal distension, vomiting or failure to thrive [32,34,35]. The web is almost always attached to the wall of the 2nd portion of the duodenum near the ampulla of Vater [32][33][34], but webs in the 3rd and 4th portions of the duodenum have been described [35]. With time the web can stretch, forming the so-called duodenal diverticulum, which can stretch into the more distal duodenum [33,36].…”

“…Duodenal webs are typically treated with duodenotomy and web excision or duodenoplasty [4,7,10,32,35]. Endoscopic resection has been explored but has demonstrated increased complications such as bleeding and post-surgical scarring, resulting in recurrent stenosis [80,81].…”

Resection of a duodenal web using single-incision pediatric endosurgery

“…In a 10-year case review, almost 20% were due to a duodenal web [5]. 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].…”

Multiple Foreign bodies entrapped at Duodenal Web

“…The intrinsic lesions include primarily duodenal atresia or web. [1,2] Duodenal webs may present late with features of partial duodenal obstruction; delay in presentation depends upon size of the aperture of duodenal web. Bigger apertures may even delay its diagnosis until adulthood.…”