Congenital Duodenal Web Research Articles

Endoscopic radial incision and cutting method for adult congenital duodenal webs: A case report

BACKGROUND Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea, vomiting, and postprandial fullness. The treatment for this disease is mostly surgical. Endoscopic treatment techniques have been developed and attempted for this disease. Endoscopic radial incision and cutting (RIC) techniques are reportedly very effective in benign anastomotic stricture. This case report highlights the effectiveness and safety of endoscopic RIC as a minimally invasive treatment for adult congenital duodenal webs. CASE SUMMARY A 23-year-old female patient with indigestion was referred to a tertiary hospital. The patient complained of postprandial fullness in the epigastric region. Previous physical examinations or blood tests indicated no abnormalities. Computed tomography revealed an eccentric broad-based delayed-enhancing mass-like lesion in the second portion of the duodenum. Endoscopy showed an enlarged gastric cavity and a significantly dilated duodenal bulb; a very small hole was observed in the distal part of the second portion, and scope passage was not possible. Gastrografin upper gastrointestinal series was performed, revealing an intraduodenal barium contrast-filled sac with a curvilinear narrow radiolucent rim, a typical "windsock" sign. Endoscopic RIC was performed on the duodenal web. The patient recovered uneventfully. Follow-up endoscopy showed a patent duodenal lumen without any residual stenosis. The patient reported complete resolution of symptoms at the 18-month follow-up. CONCLUSION Endoscopic RIC may be an effective treatment for congenital duodenal webs in adults.

Balloon dilation of congenital perforated duodenal web in newborns: Evaluation of short and long-term results.

Incomplete congenital duodenal obstruction (ICDO) is caused by a congenitally perforated duodenal web (CPDW). Currently, only six cases of balloon dilatation of the PDW in newborns have been described. To present our experience of balloon dilatation of a perforated duodenal membrane in newborns with ICDO. Five newborns who underwent balloon dilatation of the CPDW along a preinstalled guidewire between 2021 and 2023 were included. Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group. In all cases, good anatomical and clinical results were obtained. In three cases, a follow-up study was conducted after 1 year. The average time to start enteral feeding per os was significantly earlier in the study group (4.4 d) than in the laparotomic group (21.2 days; P < 0.0001). The time spent by patients in the intensive care unit and hospital after balloon dilatation was also significantly shorter. We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows: (1) Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web; (2) presence of endoscopic signs of CPDW; (3) successful cannulation with a guidewire performed parallel to the endoscope, with holes in the congenital duodenal web; and (4) successful positioning of the balloon performed along a freestanding guidewire on the web. Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.

The First Case of Endoscopic Balloon Dilatation for a Newborn With a Congenital Duodenal Web in Korea

The First Case of Endoscopic Balloon Dilatation for a Newborn With a Congenital Duodenal Web in Korea

Congenital duodenal web causing partial obstruction with recurrent vomiting and abdominal distention in a toddler boy: a case report

BackgroundThe duodenal web is a thin, elongated, web-like structure that is one of the factors contributing to duodenal obstruction. Only 100 cases have been reported in the literature. We present a 2.5-year-old cachectic Afghan child who did not have any overt signs and symptoms of intestinal obstruction, like recurrent vomiting, abdominal distention, and weight loss. The web was discovered near the intersection of the third and fourth portions, which is an uncommon location for the duodenal web. The late presentation of congenital duodenal web with partial obstruction is rare but well-known and has been reported in this case.Case presentationA 2.5-year-old cachectic Afghan child who had recurrent vomiting and experienced abdominal distention was brought to Maiwand Teaching Hospital from the Jabelsuraj region of Parwan province. The patient was suffering from unusual signs and symptoms like recurrent vomiting, abdominal distention, weight loss, and constipation. The diagnosis of these anomalies was established by a detailed history, clinical features, and abdominal CT scan. In the computerized tomography scanning (CT-Scan) image reported, there was a web with stenosis and partial obstruction in the distal aspect of the third-to-fourth portion of the duodenum. After preoperative stabilization, the child was taken for surgery. The abdomen was opened by a right upper abdominal transverse incision. After web resection and duodenoplasty, the patient was shifted to the recovery room in satisfactory condition. The child was allowed to feed after 8 days, which he tolerated well.ConclusionCongenital duodenal web with partial obstruction is typically observed in the second and third years of life. It is suspected in patients with recurrent vomiting, abdominal distention, weight loss, and constipation. Partial obstruction may not have an overt presentation, making it a challenging diagnosis for general practitioners. Abdomen X-ray and CT scan usually confirm the diagnosis, and successful surgical intervention is recommended.

Distal duodenal web with malrotation: An unusual finding.

The most common site of the congenital duodenal web is the second part. Web distal to the second part of the duodenum is rare. It mimics the windsock deformity. Diagnosis may be missed if accompanying malrotation is present. We hereby report two cases of distal duodenal webs associated with malrotation and challenges in their diagnosis and management.

Congenital duodenal web in a patient with Down syndrome presenting with early hematemesis

Congenital duodenal web in a patient with Down syndrome presenting with early hematemesis

Duodenal Obstruction in The First Month of Life

Introduction: Duodenal obstruction in the 1st month of life is the most common etiology of bowelobstruction. We aim to analyzethe causes, clinical and diagnostic spectrum, management and surgicaloutcome of duodenal obstruction in the first month of life. The method that we used were 26 newborns ofduodenal obstruction reviewed by a cross- sectional study for 30 months (January 2017 - Jun 2019).All of thenewborns were investigated to the demographic details, causes, clinical presentation, associated anomalies,radiological findings, surgery performed and their outcome. Our results show that of 26 neonates (16 males,10 females). 17 newborns were presented within the first 3 days of life. The mean gestational age was 36.88weeks (10 preterms, 16 terms). The birth weight was normal in 16 newborns. Duodenal atresia was the mostfrequent cause in 9 (35%) neonates followed by the annular pancreas in 8(31%), malrotation in 6(23%),congenital duodenal web in 2 (8%)and congenital peritoneal band in 1 (4%). Greenish vomiting was themost common presentation in 38%. Double bubble gases by abdominal x- ray in 65%.Associated anomalieswere noted in 58%, cardiac defects being the most frequent 53%. Duodenoduodenostomy was performedin 73%. Feeding intolerance is the most frequent complication in 48%. 4 (15%) neonates died, mostlyin malrotation 50%. The commonest cause of death was midgut gangrene in 50%.We concluded that theDuodenal obstruction is a common problem in newborns. Greenish vomiting was the most common warningfinding. Associated anomalies were noted in more than half, cardiac defects being the most frequent. Earlydiagnosis and treatment is key to reduce post-surgical complications and improving outcome.

Single balloon dilation of symptomatic duodenal web: Long-term success

Abstract Duodenal webs in neonates and infants have been traditionally managed with open or laparoscopic surgery. Surgical management has been associated with high morbidity and mortality and prolonged length of stay. Other treatments include endoscopic resection of the web with cautery or laser energy. This modality carries a high risk of perforation. Endoscopic balloon dilatation has been recently reported with good clinical outcome. Most of the patients reported in the literature required serial balloon dilatations to achieve resolution of the symptoms. We report a 10-month-old infant with duodenal obstruction secondary to a congenital duodenal web. He was successfully managed with a single high-pressure balloon dilatation using an interventional radiology technique. He tolerated liquid diet on day 2 post procedure and was discharged home on day 3. He has remained asymptomatic after 4 years of follow-up.

A Rare Case of a Congenital Duodenal Web in an Adult Patient

Case: A 24 year-old female presented with postprandial bloating, heartburn and occasional vomiting for the last couple of months. Her abdomen is distended on exam with no significant tenderness. She underwent an upper endoscopy that showed erosive esophagitis and a large phytobezoar in the stomach that prevented advancing the scope further. A repeat esophagogastroduodenoscopy revealed a dilated stomach and duodenal bulb with suspected duodenal stricture. X-ray of the stomach with gastrograffin demonstrated significant dilation of the duodenal bulb with delay of the contrast material passage beyond this region raising the possibility of a congenital duodenal web. Computed tomography of the abdomen reported significantly distended first and second portions of the duodenum. Patient underwent a repeat EGD that showed again a web-like constriction in the third part of the duodenum that was balloon dilated to 12 mm. The standard upper endoscope did not reach to the stricture area; therefore this was exchanged for a pediatric colonoscope for dilation. The patient never had anemia or nutritional deficiencies of any kind. Post dilation, the patient felt improvement in her symptoms and she is planned to have a second dilation later on. Discussion: Congenital duodenal anomalies are rarely diagnosed in adulthood. Patients with duodenal webs usually present with epigastric discomfort, bloating and postprandial emesis. These malformations infrequently cause intestinal obstruction. Because of the gastric outlet obstruction, acid reflux symptoms and heartburn are very common. Occasionally, they remain asymptomatic until adulthood and, because they are unusual, may not be diagnosed. Most of patients with duodenal webs have weight loss, nutritional deficiencies and anemia. Our patient was gaining weight instead, which made the suspicion for her having a gastrointestinal malformation unlikely on presentation. Acquired duodenal webs reported in the literature are mostly associated with NSAIDs use, previous abdominal surgeries or pancreatitis. Our patient does not have any medical problems and her symptoms started during her childhood but went unnoticeable till her reflux symptoms were refractory to acid suppression therapy. Management strategies are related to the degree of obstruction; they range from balloon dilation to duodenal web excision. Surgical correction is usually the definitive treatment to restore the intestinal continuity.

Fenestrated Duodenal Membrane in a Girl with Down Syndrome and Celiac Disease

Background: Fenestrated duodenal membrane is a form of congenital duodenal webs in whom the diagnosis is missed or delayed often. Case presentation: We will present the case of a two-year- old girl diagnosed at birth with Down syndrome and 12 month old she was diagnosed with celiac disease. After gluten free diet this girl presented a good weight gain but her mother referred that last months she was vomiting frequently. Her mother denied to have seen bilious vomiting but she noticed in vomiting some kind of foods swallowing one or two weeks ago. Radiological images were confident with duodenal obstruction. After surgical laparotomy we noticed a fenestrated duodenal membrane. Discussion: Fenestrated duodenal membrane is a rare congenital disorder. Sometimes the diagnostic may be delayed when the symptoms are not characteristic or dedicated to a different pathology. In our case nonbilious vomiting and celiac disease made us to underestimate initially this congenital anomaly. Conclusion: Every child with Down syndrome should be evaluated for rare digestive disorder despite of no characteristic signs or the presence of another digestive pathology. Surgery remains the gold standard of therapy.

Duodenal web resection via hybrid natural orifice transluminal endoscopic surgery (NOTES)

Congenital duodenal atresia, stenosis, and webs are a common cause of proximal obstruction in the newborn period. A variety of surgical techniques have been described for the treatment of duodenal webs. Open and laparoscopic duodenotomy with web resection have been well described; endoscopic resection has also shown to have promising success. We describe a case of a 2-year-old male with a duodenal web, which was resected via an existing gastrostomy site utilizing a modified hybrid natural orifice transluminal endoscopic surgery (NOTES). • Duodenal webs are a common cause of neonatal duodenal obstruction. • High index of suspicion is needed to diagnose duodenal webs after infancy. • Hybrid NOTES is a safe and effective approach for the excision of duodenal webs. • Approach can be performed without an endoscope.

923 Pediatric Therapeutic Endoscopy: Endoscopic Management of a Congenital Duodenal Web

Congenital duodenal webs are a rare cause of gastrointestinal dysfunction in infants and children. The traditional approach to treatment has been surgical intervention, by way of excision or bypass. We present a case of successful endoscopic management of a congenital duodenal web in an 8 year old girl who presents with a duodenal obstruction.

Gastric outlet obstruction caused by focal nodular hyperplasia of the liver: A case report and literature review

INTRODUCTIONHere, we present a case of gastric outlet obstruction due to focal nodular hyperplasia of the liver. PRESENTATION OF CASEA 23-year-old female presented to our emergency clinic with nausea, vomiting, and abdominal pain. Endoscopy showed that the prepyloric region of the stomach was externally compressed by a lesion. Computed tomography and magnetic resonance imaging revealed a 70mm solid mass originating from the liver, extending caudally in an exophytic manner, and compressing the stomach. Laparotomy revealed an irregular and exophytic mass originating from the liver, which caused gastric outlet obstruction. The mass was resected with a 10mm safety margin. The histopathology report of the mass returned as focal nodular hyperplasia. DISCUSSIONGastric outlet obstruction is a clinical syndrome characterized by abdominal pain, nausea, and postprandial vomiting. This clinical condition frequently develops as a result of peptic ulcer disease, pyloric stenosis, and obstruction of pylorus by foreign bodies including phytobezoars, congenital duodenal webs, malignant disorders, and various lesions externally compressing the stomach. Gastric outlet obstruction due to hepatic lesions is extremely rare; few cases have been reported. CONCLUSIONThis is the first reported case of gastric outlet obstruction that developed due to focal nodular hyperplasia of the liver.

Technical Aspects of the Laparoscopic Management of a Late Presenting Duodenal Web

The value of laparoscopy in repair of congenital duodenal webs is yet to be established and techniques are evolving. Described are technical details of a successful laparoscopic web ablation without duodenoplasty.

Congenital Duodenal Web Associated with a Foreign Body (Go Stone) in a 10-Year-Old Girl

Congenital Duodenal Web Associated with a Foreign Body (Go Stone) in a 10-Year-Old Girl

Endoscopic laser ablation of obstructing congenital duodenal webs in the newborn: A case report of limited success with criteria for patient selection

Standard approaches to intrinsic obstructing duodenal lesions in the newborn include laparotomy with enteroenterostomy, bypassing the obstruction, or duoduodenotomy with excision. The advent of improved pediatric flexible fiberoptic endoscopes and fiberoptic laser technology makes endoscopic ablation of duodenal webs and windsocks in the newborn possible.

Adult duodenal webs: A rare cause of obstruction

Two patients are described with congenital duodenal webs. Both presented with increasing heartburn, an unusual symptom for this condition. The radiological appearances at barium meal examination were misinterpreted in both cases. The radiological features of duodenal webs and their differentiation from intraluminal diverticula are discussed.

Adult Duodenal Webs

Intestinal obstruction in adults caused by congenital duodenal webs is uncommon. Roentgenographic and endoscopic diagnosis is difficult owing to frequently nonspecific roentgenographic findings and the obliteration of normal pyloric endoscopic anatomy. The ultimate diagnosis of this lesion is likely to be made at the time of cellotomy for suspected obstructing peptic ulcer disease with the observation of an unobstructed pylorus. We studied three recent cases and reviewed the pertinent literature, which demonstrated problems associated with preoperative and surgical diagnosis and management. Diagnosis of duodenal webs should be suspected in all patients with gastric or high duodenal obstruction and investigated by digital duodenal exploration at the time of surgery.