Endoscopic Division of Duodenal Web Causing Near Obstruction in 2-Year-Old with Trisomy 21

Abstract

Introduction: Surgical intervention for duodenal atresia most commonly entails duodenoduodenostomy in the neonatal period. Occasionally, type I duodenal atresia with incomplete obstruction may go undiagnosed until later in life. Endoscopic approach to dividing intestinal webs has been reported as effective in patients as young as 7 days of age, and can be a useful modality particularly in patients with comorbidities who may not tolerate open or laparoscopic surgery. The video demonstrates upper gastrointestinal endoscopy with radial incision and dilation of partially obstructing duodenal web; total runtime is 3 minutes and 19 seconds. Materials and Methods: A 2-year-old female with a history of trisomy 21 and tetralogy of Fallot underwent laparoscopic and endoscopic exploration of intestinal obstruction as seen on upper gastrointestinal series for symptoms of recurrent emesis and weight loss. After laparoscopy confirmed a duodenal web as the cause of intestinal obstruction, endoscopic division of the membrane was carried out with a triangle tip electrocautery knife and 15 mm radially dilating balloon. Results: The patient tolerated the procedure well, tolerating full age-appropriate diet by time of discharge on postoperative day 2. She remains asymptomatic as of 6 months postoperatively. Conclusions: This report describes an effective endoscopic approach for definitive treatment of a duodenal web in a 2-year-old girl with trisomy 21 with laparoscopy to confirm no intra-abdominal obstructive process or complication from endoscopy. Endoscopy enables minimal recovery time and suggests an improved method of duodenal web division over pure surgical intervention. No competing financial interests exist. Runtime of video: 3 mins 19 secs