Duodenal Web Research Articles

Thirty‐two‐month‐old with multiple duodenal webs diagnosed after failed gastrojejunostomy exchange successfully treated with combination endoscopic therapy

AbstractIntestinal webs are either congenital or acquired. There are few reported cases of either chemotherapy or nonsteroidal anti‐inflammatory medications leading to acquired intestinal webs in adults. There are limited descriptions of endoscopic interventions used for therapy of numerous duodenal webs in pediatrics. Here, we describe a 32‐month‐old patient undergoing chemotherapy who had multiple duodenal webs. The patient was diagnosed after failed gastrojejunostomy tube exchange via atypical contrast filling pattern and direct visualization with endoscopy. This patient likely has acquired duodenal webs from the combination of nonsteroidal anti‐inflammatory drug containing chemotherapy treatment and repeated tube trauma. Treatment involved serial esophagogastroduodenoscopy with a combination of endoscopic therapy including balloon dilation and incisional therapy with insulated‐tip knife and cautery scissors. The patient now tolerates G‐tube feedings.

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.

A case of intermittent bilious emesis in a term neonate: a case report and brief review of literature

BackgroundNeonatal intestinal obstruction is a complex condition that poses challenge in management. Prompt recognition and appropriate management are crucial to prevent complications. We present a case of a term neonate with intermittent bilious vomiting.Case presentationThe baby underwent routinely performed investigations, including abdominal radiography and ultrasound, which provided inconclusive results. However, contrast-enhanced computed tomography revealed a web at duodenojejunal flexure. Exploratory laparotomy confirmed the diagnosis, and surgical intervention was performed. The baby’s postoperative course was prolonged with a gradual transition from parenteral nutrition to enteral feeds.ConclusionThis case highlights a rare cause of intestinal obstruction, the unusual location of duodenal web, the importance of maintaining a high index of suspicion for intestinal obstruction, even in the absence of classical signs, and the value of utilizing contrast-enhanced computed tomography when initial investigations are inconclusive.

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.

Endoscopic incision of the duodenal descending incomplete obstruction caused by duodenal web (with video)

Endoscopic incision of the duodenal descending incomplete obstruction caused by duodenal web (with video)

Development of a Modified Duodenum Traction Technique in Laparoscopic Duodenal Web Excision.

Introduction: Laparoscopic duodenal web resection surgery remains safe in neonates. The pearls in laparoscopic duodenal web excision are a proper and stable duodenal exposure. Herein, we present a modified duodenal traction technique, which can improve operative field exposure in laparoscopic surgery. Material and Methods: This modified technique was performed in 54 patients during laparoscopic duodenal web resection surgery at our center. It was performed using a 5-0 PDS-II suture, which was introduced percutaneously at 1-2 cm under either side of the costal margin at the anterior axillary line, respectively, to retract the duodenum. Results: Perioperative data of these patients and short-term follow-up data of duodenal web patients were retrospectively reviewed. All 54 procedures were completed without conversion to open surgery or requiring additional ports. Patients' mean age at surgery was 5 days (range 2-30 days), and the median weight at the time of surgery was 3.25 kg (range 2.52-3.88 kg). Eight patients (14.8%) had complete membranes, whereas 46 (85.2%) had a membrane with a hole. The mean time required for this technique was 336 (range 216-416) seconds and the mean duration of the entire surgery was 77 (range 65-89) minutes. The mean postoperative hospital stay was 16 (range 9-90) days and no postoperative complication related to the suspension procedure occurred. Conclusion: Our outcomes demonstrated the modified duodenal traction technique is a feasible and ideal method during laparoscopic duodenal web resection surgery.

Neonatal Intestinal Obstruction Caused by a Perforated Duodenal Web

Aim: To report the clinical courses of two patients with intestinal obstruction caused by duodenal web, who were diagnosed with this rare congenital anomaly at Clinical Hospital Center Rijeka in a span of 5 months. Case report: One of the patients was prenatally suspected to have duodenal obstruction due to ultrasonographic findings, while the other showed signs of obstruction by not tolerating oral intake from the second day of life (DOL). Ceasing enteral feeding, placing a nasogastric tube and introducing intravenous hydration and parenteral nutrition was performed as initial management. Abdominal ultrasonography, abdominal radiography, upper gastrointestinal contrast study and contrast enema were performed but showed no signs of obstruction. Both patients showed improvement in tolerating oral intake over the next few days. However, the first patient did not tolerate meals exceeding 15 mL of infant formula, and the second patient again did not tolerate any oral intake from the 15th day of life. A broad diagnostic workup was repeated but did not show conclusive evidence of obstruction regarding the first patient. Esophagogastroduodenoscopy found duodenal obstruction of unknown origin regarding the second patient. Laparotomy was performed on the 19th and 25th DOL, respectively. Duodenal web was visualized and excised in both patients following duodenotomy. Postoperative recovery was orderly with minor nonsurgical complications. The patients were discharged from hospital on the 21st and 36th postoperative day, respectively. Conclusions: Diagnosing a perforated duodenal web is often challenging because of possible intermittent nature of its symptoms. Exploratory laparotomy is sometimes required to reach diagnosis.

Duodenal Stenosis: A Case Report

Background: Congenital duodenal stenosis in pediatric patients was often underreported due to its non-conspicuous signs and symptoms. Diagnosing duodenal stenosis is often challenging as this disease causes partial intestinal obstruction and thus presents with more indolent and atypical clinical manifestations. This case report aims to describe the atypical case of pediatric duodenal stenosis which presented with recurrent vomiting and poor weight gain as well as highlight some of the diagnostic challenges.&#x0D; Case: A 7-month-old girl was admitted to the emergency room with chief complaint of recurrent vomiting in the last 2 days prior to hospital admission. Patient had a history of recurrent bilious vomiting at the age of 3 days old with a frequency of 3-4 times a day and were admitted to the hospital for 2 weeks. Parents also reported of poor weight gain in the last 3 months. Abdominal X-Ray series showed dilatation of the small intestines immediately after pylorus and stack of coins sign. Esophageal endoscopic evaluation showed signs of severe GERD with a pyloric gap as well as a suspicion of a duodenal web&#x0D; Discussion: Congenital obstruction at the duodenum may occurs due to intrinsic or extrinsic etiology. Failure of duodenal re-canalization during the 8-10th week of embryological development is thought to be the main cause of intrinsic duodenal obstruction (atresia, stenosis or duodenal web). The appearance of clinical manifestation of duodenal stenosis depends on the degree of stenosis itself.&#x0D; Conclusion: Congenital duodenal stenosis may present with atypical presentations in neonates which requires clinicians to be fully aware of this diagnosis to ensure timely therapy. The main management of duodenal stenosis is surgery, however fluid administration, decompressing as well as other supportive treatment are equally crucial to ensure better outcome for the patient.

Endoscopic Management of a Double Duodenal Web: A Case Report of a Rare Alimentary Anomaly.

Duodenal webs are a rare clinical entity with the presentation of a double duodenal web being exceedingly uncommon. Management of duodenal webs traditionally involves duodenal web excision with duodenoduodenostomy, which is usually performed via a laparoscopic or an open approach. We report the case of a 6-month-old child who presented with progressively worsening bilious emesis with imaging findings concerning for a duodenal web. Endoscopic evaluation was performed that identified 2 webs in the fourth portion of the duodenum. These were managed completely endoscopically with balloon dilation. Although surgery is the mainstay of treatment of duodenal webs, this patient was successfully managed by endoscopic intervention without the need for open or laparoscopic excision, which has not been previously described for double duodenal webs. This work demonstrates the safety and efficacy of endoscopic management for infants with this anomaly.

Delayed presentation of duodenal atresia.

The most common type of duodenal atresia (DA) (Type I), also known as duodenal web or membrane can present later in infancy or early childhood if the membrane or web is fenestrated. We describe six patients with delayed presentation of DA. Retrospective review of hospital records of six patients with delayed presentation of DA due to fenestrated web managed in Paediatric Surgery Department at a tertiary care institute over a period of 2 years (January 2019 to December 2020) was done. The data of these patients were analysed on the basis of age at presentation, clinical presentation, associated anomalies, radiological findings, intra-operative findings, management and postoperative course. The median age at presentation was 6.5 months (range: 1 month to 10 years). There were four males and two females. The most common presentation was emesis seen in all six patients. Two patients had Down syndrome. Associated congenital anomalies were cardiac in one patient, anterior ectopic anus in one patient and malrotation of midgut in one patient. Upper gastrointestinal contrast suggested incomplete duodenal obstruction in all patients. At laparotomy, fenestrated duodenal membrane was observed in all patients - preampullary in three patients and postampullary in three patients. Lateral duodenotomy, web excision and transverse closure was done in all six patients. The postoperative period was uneventful in all patients and mean duration of hospital stay was 9 days. Fenestrated duodenal webs present a diagnostic challenge to the paediatric surgeons because of delayed and variable clinical presentation. A modification of the present classification of DA has been proposed in this study which would help in better reporting of epidemiology and aid in early diagnosis of this congenital anomaly.

Anatomical Diseases Caused by Congenital Duodenal Abnormalities

Disorders of duodenal anatomy are rare and originate during the early embryological development of the foregut. These disorders are associated with significant morbidity in children; however, they may remain undetected during childhood and present during adolescence or adulthood. Duodenal atresia or web, annular pancreas, Ladd’s bands associated with midgut volvulus, and preduodenal portal vein represent duodenal anomalies that may cause partial or complete duodenal obstruction. Duodenal atresia and web occur secondary to incomplete recanalization of the duodenal lumen during the 8th to 10th week of gestation. These anomalies usually require surgical correction; however, the role of endoscopic interventions using innovative equipment is being investigated. Duodenal duplication cysts are an extremely rare congenital anomaly. Most abut the second or third portion of the duodenum and histologically show the normal duodenal wall layers. These lesions clinically present with abdominal pain, weight loss, vomiting, pancreatitis, or features of biliary tract obstruction. Imaging studies including transabdominal ultrasonography, computed tomography, MRI, and endoscopic ultrasonography are useful for detection of the cystic structure. Surgery is the conventional therapeutic modality used for management of duodenal duplication cysts; however, marsupialization (endoscopic intervention to establish communication between the cyst cavity and the duodenal lumen to facilitate duodenal drainage of cystic contents) is increasingly being performed in clinical practice. Duodenum inversum and duodenal diverticula are congenital duodenal disorders that require endoscopic or surgical management in symptomatic patients.

Innovative Endoscopic Management of a Duodenal Web Using Balloon Dilatation and a Gastrojejunal Tube in an Infant with Complex Esophageal Atresia.

Introduction: Congenital partial duodenal obstruction (CPDO) is a rare type of intestinal obstruction, including webs and stenoses. Treatment has usually been operative by laparoscopy or laparotomy. Some have proposed endoscopic treatment due to a higher surgical risk in patients with CPDO. However, restenosis seems to be frequent after simple balloon dilatation. Material and Methods: We report on a patient with CPDO and complex esophageal atresia in whom we used a gastrojejunal tube to keep the lumen open after endoscopic balloon dilatation over a guidewire. Results: Follow-up endoscopy showed no evidence of restenosis. During the third endoscopy, the opening could be dilated to 15 mm without any complications and the gastrojejunal tube was removed. Since then, there were no clinical signs of obstruction, and no further endoscopic intervention was necessary. Discussion and Conclusion: Using a gastrojejunal tube after endoscopic balloon dilatation of a duodenal web may lower the risk of restenosis. This technique should be considered in patients with comorbidities and considerable surgical risk that have a gastrostomy in place.

Gastric pneumatosis in a child with congenital duodenal obstruction

Pneumatosis of the foregut is an extremely rare finding which may indicate a potentially serious condition. In newborn the presence of gastric intramural gas is mainly associated to necrotizing enterocolitis and is considered a condition which correlates with a poor prognosis. In infant and children pneumatosis of foregut may be secondary to several causes such as infection, mucosal ischemia, caustic ingestion, gastrointestinal obstruction or mucosal injury occurred during endoscopic procedure. Intramural gastric gas can be classified as “gastric emphysema” (GE) when a mechanical injury is the main causal factor or as “emphysematous gastritis” (EG) in cases of underlying gastrointestinal infection. Portal venous gas is also a rare condition. Necrotic bowel wall dues to infection or ischemia, associated with increased intraluminal pressure, seems to favor the entry of the air into portal venous system. We report a case of gastric pneumatosis associated to portal venous gas in a child affected by Down's Syndrome with a duodenal web and concomitant bacterial and mycotic gastric colonization.

Congenital Stenosis of the Duodenum due to Duodenal Web in a Neonate: A Case Report

Congenital stenosis of the duodenum secondary to duodenal web is a rare and predominantly pediatric condition due to incomplete recanalization of the duodenal lumen during early gestation. The windsock appearance on a fluoroscopic examination of the upper gastrointestinal tract is pathognomonic for obstructive processes in the duodenum. Here, we report a surgically proven case of duodenal web in an infant.

Indocyanine green localization for laparoscopic duodenal web excision

BackgroundA duodenal web refers to partial or complete obstruction of the duodenum due to a membranous web. When looking at the serosal side of the intestine during duodenal web excision, especially during laparoscopic surgery, determining the web origin might be challenging. This study aimed to determine the efficacy of intraduodenum indocyanine green injection and near-infrared light during laparoscopic surgery in enhancing the ability to identify duodenal web localization. MethodsWe used intraduodenum indocyanine green injection to unequivocally recognize the duodenal web and facilitate laparoscopic excision. The clinical analysis was based on a male neonatal case with duodenal web admitted to our hospital. After the patient was placed in the supine position, 5 mL of ICG was injected via a 6-Fr nasogastric tube. The fluorescence was visualized in the white light and near-infrared light dual-mode of the camera system, localizing the duodenal precisely and in real-time. ResultsLaparoscopically, the duodenal web was accurately identified and removed with intraduodenum indocyanine green visualization under near-infrared light. The procedure was completed successfully, and the patient showed good postoperative outcomes. ConclusionsIntraduodenum indocyanine green injection during laparoscopic surgery is a feasible adjuvant for duodenal web localization, showing improvements in terms of outcomes compared to previous methods of determining the duodenal web location.

Annular Pancreas in infancy

: Annular pancreas is a rare congenital disorder where the symptoms that appear in this patient are symptoms of obstruction caused by the presence of pancreatic tissue that forms a ring around the descending part of the duodenum. The annular pancreas has a ratio of 1:20,000 births that may show stenotic or obstructive symptoms early in life. With a plain abdominal radiograph taken in the erect position, a “double bubble” appearance is seen, which is typical of the annular pancreas. In this case , A boy 10 month, with chief complaint vomiting, with containt vomiting every time he eat (breast milk). It had been suffered since he was born. Patient was born by midwife, aterm. Since he born, patient used took antivomitus from pediatric. Patient has been documented by barium meal to hospitalization, and was differential diagnosed with obstruction partial duodenum; duodenal web; pyloric stenosis; annulare pancreas with right scrotalis hernia. In these patient the treatment with perform Duodeno-Jejunustomy. Keywords : Annular pancreas, double bubble, Duodeno-Jejunustomy

Duodenal and Pyloric Web in Children: Clinical Presentation and Management.

Background:Duodenal and pyloric web (DW/PW) can present at any age, symptoms depend upon the location of the web along with the presence and size of the opening in the web. The surgical management is not straightforward always. Here, in this study, we aim to assess clinical characteristics, management, and outcome of children with DW/PW.Materials and Methodology:This was a retrospective study from 2005 to 2019, and data were collected from record registers. All children of DW/PW presented between this duration were included in this study.Results:A total of 45 patients (age range = 1 day to 11 years) included in the study, 40 had DW while 5 had PW. Seven patients were diagnosed antenatally and 20 patients had associated congenital anomalies. Most patients presented with vomiting either bilious or nonbilious. Plain X-ray was sufficient for the diagnosis in 60% of patients, the rest diagnosed on contrast study. The web excision and pyloroplasty were done for PW. The web excision and Heineke-Mikulicz type enteroplasty was the preferred surgery for DW but some patients were required Kimura's duodeno-duodenostomy. For postoperative nutrition, enteral feeding was established through the placement of a feeding tube beyond anastomosis. Ten patients died due to septicemia and associated anomalies. Four patients had a minor leak which was managed by conservative means. Four patients required redo surgery, adhesive obstruction was the most common indication. During follow-up, all 35 patients were doing well with no major complaints.Conclusion:DW/PW has different presentations as compared to other intestinal atresia and can present at any age. A contrast study confirms the diagnosis when plain X-ray is inconclusive. Associated anomalies and septicemia are the poor prognostic indicators. Postoperative enteral feeding helps in maintaining adequate nutrition and improves the outcome even in children with a minor anastomotic leak.