Duodenal Web Research Articles

Congenital duodenal obstruction with delayed presentation: seven years of experience.

IntroductionThe duodenum is the most common site for congenital intestinal obstruction. The duodenal web with a central hole can present without any overt signs of obstruction at a later age.Material and methodsOver a 7-year period, children with congenital intestinal obstruction were identified in this study. The complications and operative findings of patients with duodenal web with conditions such as wind sock deformity and delayed diagnosis were evaluated in this study.ResultsThis study included 81 infants with congenital intestinal obstruction. At operation, 48 patients demonstrated duodenal obstruction with atresia in 27, annular pancreas in 15 and malrotation in 6. Also, we observed incomplete obstruction of the duodenum due to a fenestrated web in 8 patients. The age of these patients at operation time ranged from 5 days to 72 months. Fifty percent of affected patients were associated with trisomy 21, all of whom exhibited failure to thrive due to food intolerance. The patients older than 2 years presented with major complications of gastroesophageal reflux such as esophageal ulcer, stricture and dysphagia. Additionally we had a unique case of a patient who had been referred with an epigastric mass. During the operation, we found 440 seeds of various fruits in the stomach and the first portion of the duodenum.ConclusionsOur study emphasizes that duodenal web with a central hole can present without signs of obstruction at a later age with only failure to thrive and food intolerance. Therefore a high index of suspicion is necessary for diagnosis when it presents beyond the usual age.

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.

Delayed presentation of a duodenal web

Abstract Duodenal atresia and web are common causes of intestinal obstruction in early infancy. Their incidence ranges between 1 in 10,000 to 1 in 40,000 live births. Unlike duodenal atresia which is diagnosed early, even antenatally; A web presents later depending on the size of the aperture in the web. It usually presents with bilious or non bilious vomiting. We present an unusual presentation of duodenal web in a three and a half years old boy who presented with a 12 months history of abdominal distension and vomiting every 2nd or 3rd day. Plain abdominal imaging showed radiopaque foreign bodies below the diaphragm. As the natural history for majority of ingested foreign bodies is natural passage; He was managed expectantly elsewhere. Eventually, 12 months later, the patient presented to our center where further investigation provided the diagnosis. He was treated surgically by excision of the web. Post operatively, TPN and a trans-anastomotic tube (TAT) were used until full recovery was achieved. A high index of suspicion is the key to reaching the true diagnosis in patients presenting after the neonatal period.

Prognostic factors and concomitant anomalies in neonatal gastric perforation

ObjectiveNeonatal gastric perforation is a rare and serious issue. This study aimed to highlight the vital clinical features and identify prognostic factors in such cases. Design, setting, patients, interventions, and measurementsMedical charts from January 1997 through December 2008 were reviewed retrospectively. Neonates with a diagnosis of gastric perforation were included. ResultsThirteen patients were identified with a male:female ratio of 9:4. Five (38%) were preterm infants. The mortality rate was 30% (4/13), and the median age of onset was 3days (range: 1–14days). The most common presenting sign was abdominal distension, followed by respiratory distress and vomiting. Except for one patient in whom gastric perforation was diagnosed during surgical repair for gastroschisis, all patients had pneumoperitoneum on admission; 70% and 46% of patients had peritonitis and sepsis, respectively. Concomitant gastrointestinal (GI) tract anomalies or disorders included ischemic bowel/necrotizing enterocolitis (5 patients), intestinal malrotation (2), duodenal web (1), hiatal hernia (1), and gastroschisis (1), which necessitated secondary operations during hospitalization in 5 patients. Seven patients had leukopenia on admission, and 9 developed thrombocytopenia in the following 48h. All patients who died presented with leukopenia on admission and thrombocytopenia in the following 48h, yielding sensitivity and specificity rates of 100% and 67%, respectively. ConclusionsNeonatal gastric perforation is often concomitant with GI anomalies or inflammatory/infectious disease. Patients who were outborn and those with leucopenia, peritonitis, and thrombocytopenia development within 48h were at risk for poor outcome.

İnatçı kusma ve malnütrisyonun ayırıcı tanısında duodenal web

Duodenal atresia and stenosis are a common cause of congenital bowel obstruction. Duodenal web is rare, and is a type of congenital duodenal obstruction that occurs by abnormal embryological foregut development. Children with duodenal web are frequently presented with persistent vomiting, abdominal distention and growth retardation. Barium passage graphy and endoscopy are helpful in the diagnosis. In this article, we report an infant with duodenal web who had been investigated because of persistent vomiting and growth retardation, and who was misdiagnosed as gastroesophageal reflux.

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.

Incomplete duodenal obstruction: a rare and late presentation

Background: Incomplete duodenal obstruction accounts for only 2% of all duodenal anomalies. Because of its rarity those patients can be easily misdiagnosed and delayed in their presentation. The aim of this study is to assess these rare conditions with its delayed presentation and their outcome. Methods: Nineteen cases presented with incomplete duodenal obstruction during the period from January 2010 to January 2015. Cases with complete duodenal obstruction were excluded from the study. None of those nineteen cases were diagnosed antenatal. The assessment parameters were; their provisional preoperative diagnosis, definite post-operative diagnosis, complications related to miss or delayed diagnosis and their final outcome. Results: All nineteen cases except six presented with persistent or recurrent attacks of vomiting since birth. Their provisional clinical diagnosis was malrotation in 9 cases, duodenal stenosis in 6 cases and atresia in 4. Their final diagnosis was; duodenal stenosis or web in fifteen cases, preduodenal portal vein in two, superior mesenteric artery syndrome in one case and duodenal hematoma in one case. The cause of misdiagnosis was related to lack of experience that leads to unsuccessful exploration or delayed surgical intervention. The post-operative complications occurred in 26.3% of cases. No mortality encountered in this study. Conclusions: Rare causes of incomplete duodenal obstruction should be looked for routinely to avoid delayed presentation, misdiagnosis and unsuccessful exploration.

Congenital duodenal obstruction in neonates: a decade's experience from one center.

Congenital duodenal obstruction (CDO) is one of the most common anomalies in newborns, and accounting for nearly half of all cases of neonatal intestinal obstruction. This study aimed to review our single-center experience in managing congenital duodenal obstruction while evaluate the outcomes. We conducted a retrospective analysis of the records of all neonates dianogsed with congenital duodenal obstruction admitted to our center between January 2003 and December 2012. We analyzed demographic criteria, clinical manifestations, associated anomalies, radiologic findings, surgical methods, postoperative complications, and final outcomes. The study comprised 287 newborns (193 boys and 94 girls). Birth weight ranged from 950 g to 4850 g. Fifty-three patients were born prematurely between 28 and 36 weeks' gestation. Malrotation was diagnosed in 174 patients, annular pancreas in 66, duodenal web in 55, duodenal atresia or stenosis in 9, preduodenal portal vein in 2, and congenital band compression in 1. Twenty patients had various combinations of these conditions. Presenting symptoms included bilious vomiting, dehydration, and weight loss. X-rays of the upper abdomen demonstrated the presence of a typical double-bubble sign or air-fluid levels in 68.64% of patients, and confirmatory upper and/or lower gastrointestinal contrast studies were obtained in 64.11%. Multiple associated abnormalities were observed in 50.52% of the patients. Various surgical approaches were used, including Ladd's procedure, duodenoplasty, duodenoduodenostomy, duodenojejunostomy, or a combination of these. Seventeen patients died postoperatively and 14 required re-operation. Congenital duodenal obstruction is a complex entity with various etiologies and often includes multiple concomitant disorders. Timely diagnosis and aggressive surgery are key to improving prognosis. Care should be taken to address all of the causes of duodenal obstruction and/or associated alimentary tract anomalies during surgery.

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.

Delayed presentation of bowel obstruction in a patient with Trisomy 21: A novel method for addressing intestinal webs

Congenital duodenal anomalies, such as atresia, stricture, or webs, are a common finding in patients with Trisomy 21. We present the case of a 23 year old female with a history of Trisomy 21 and feeding intolerance who was found to have multiple duodenal and jejunal webs in the clinical setting of complete duodenal obstruction. Nine congenital webs were encountered from the proximal duodenum to the mid-jejunum, all of which were distal to a complete duodenal obstructing lesion. In this communication, we describe a novel treatment technique for addressing multiple intestinal webs without additional bowel enterotomies or resections.

Duodenal Obstruction due to Duodenal Web in Three-year-old Girl: A Case Report

Congenital duodenal obstruction is a one of the emergent surgical conditions in neonates. Almost of them were diagnosed with double-bubble sign in prenatal ultrasonography. However, partial obstruction caused from duodenal web could be overlooked. We reported a duodenal web in early childhood. A three-year-old girl visited at our pediatric clinic for constipation. She had been showed non-bilious vomiting after weaning meal since 6 months old of her age, but her weight was relevant for 50-75 percentile of growth curve. Barium enema was initially checked, but any abnormal finding was not found. We noticed the severely distended stomach and 1st portion of duodenum. Upper gastrointestinal series revealed partial obstruction in 2nd portion of duodenum. After laparotomy, we found the transitional zone of duodenum and identified a duodenal web via duodenotomy. We performed duodeno-duodenostomy without any injury of ampulla of Vater. She was recovered uneventfully. During 6 months after operation, she does well without any gastrointestinal symptoms or signs, such as vomiting or constipation.

Duodenal web associated with malrotation and review of literature

Intestinal obstruction due to midgut malrotation in neonates is well known. The incidence of malrotation in newborns is around 1:500 and the symptomatic incidence is 1:6000 births. Duodenal web as a cause of intestinal obstruction is less common and is reported to be 1:10 000–1:40 000. Malrotation is known to be associated with other congenital obstructive anomalies including duodenal atresia, stenosis and duodenal web. But, intestinal obstruction due to malrotation associated with duodenal web has been reported only rarely with a few published cases in our literature review. We present a case of intestinal obstruction diagnosed in the prenatal period via sonogram. A plain X-ray of the abdomen after birth showed a distended duodenum with paucity of air distally suggesting duodenal obstruction. An exploratory laparotomy showed a duodenal web proximal to the sphincter of oddi. The patient also had an associated malrotation and underwent Ladd's procedure and appendectomy. The post-operative period was uneventful.

Missed duodenal web with foreign body impaction in an operated case of midgut malrotation with Down′s syndrome - A diagnosis delayed by endoscopy

ABSTRACT“Always look for duodenal obstruction in a case of malrotation”, this dictum has to be followed. The patient was operated for midgut malrotation at day 2 of life followed by foreign body removal by upper gastrointestinal endoscopy at 2 years of age. We report atwo and half year male child with Down′s syndrome who presented to us with history suggestive of recurrent upper gastrointestinal tract obstruction. During surgery a post sphincteric duodenum web was confirmed and foreign body (berry seed) which had impacted proximal to it was removed. The web was excised and the duodenum, split longitudinally, sutured transversely. The postoperative course was uneventful and patient is asymptomatic at follow up. This case illustrates that diagnosis was delayed for 2΍ years after initial presentation in early neonatal age. (Dig Endosc 2013;4(1):10–12)

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.

A rare association between dextrogastria, duodenal web, and intestinal malrotation in newborns

Dextrogastria alone is an exceptional anomaly of situs inversus. Only few cases have been published in the literature, the majority of which concern adults diagnosed either during laparotomy for other pathologies or accidentally during radiologic exploration. The authors report this very rare case in a female newborn in whom an isolated situs inversus affecting only the stomach was disclosed during the radiologic investigation for bilious vomiting and feeding intolerance, revealing congenital duodenal stenosis and dextrogastria. During surgery, the association of the dextrogastria with the duodenal web situated in the second part of the duodenum was established. Keywords : dextrogastria, duodenal web, malrotation

Congenital Webs of the Gastrointestinal Tract: 20 Years of Experience From a Pediatric Care Teaching Hospital in Taiwan

To classify and evaluate the clinical spectrum of congenital webs in the gastrointestinal (GI) tract, including clinical courses and related factors. A retrospective chart review was performed on 37 patients with congenital GI webs at a pediatric care teaching hospital in north Taiwan. All of the related parameters were collected and analyzed. Twelve patients had gastric webs, 22 had duodenal webs, and three had jejunal webs. The mean time to diagnosis was 1576 days for gastric webs, 116 days for duodenal and 230 days for jejunal webs. There was a statistically significant difference between the gastric and duodenal groups (p=0.001). The major symptom was vomiting (78%). Patients with duodenal webs had a high association with congenital anomalies (50%). The major anomalies included cardiac (27%) and GI anomalies (18%). Endoscopy was performed in 10 gastric cases, and all of them were noted to have positive findings, including a fixed nonfolded stenotic ring following a second gastric chamber and a real pylorus. All of the patients received surgery except for three with gastric webs, and no mortality was noted. The mean postoperative days of tolerated feeding was 6 for those with gastric webs, 10 for those with duodenal and 11 for those with jejunal webs. The clinical course of gastrointestinal webs may be chronic or obscure. A delay from onset of symptoms to treatment may exist, especially in gastric webs. We suggest that prompt endoscopic confirmation and surgical intervention for these lesions, when suspected due to clinical and radiologic abnormalities, will decrease the morbidity of unexplained recurrent symptoms or signs of GI obstruction in these patients.

Resection of a duodenal web using single-incision pediatric endosurgery

Single-incision pediatric endosurgery (SIPES) is used in many centers for routine cases such as appendectomies and cholecystectomies, but more complex procedures are still infrequently performed. We report the case of a 9-month-old girl with Down syndrome diagnosed with a duodenal web who underwent duodenal web resection and tapering using a SIPES technique. The procedure was performed through a single 2-cm incision in the umbilicus and took 209 minutes. Postoperatively, the patient was feeding well, gaining weight, and had no appreciable scar at a follow up of 6 months. SIPES duodenal web resection in an infant is a reasonable alternative to conventional triangulated laparoscopy that can be performed safely with good functional and cosmetic postoperative results.

A Case of Congenital Duodenal Web Causing Duodenal Stenosis in a Down Syndrome Child: Endoscopic Resection with an Insulated-Tip Knife

A 35-month-old girl visited our hospital with repetitive vomiting and abdominal distention; this was especially aggravated after the introduction of solid and semisolid foods. At 5 months of age, the patient, who had Down's syndrome, had undergone surgery for ventricular septal defect, atrial septal defect, and patent ductus arteriosus, and had subsequently been frequently hospitalized for respiratory infections and other viral infectious diseases. After her admission, the abdominal distension improved with fasting and intravenous fl uid therapy. Radiograph from a small-bowel series revealed a thin fi lling defect with a dilated duodenal bulb in the distal region of the second portion of the duodenum, suggesting a duodenal web, and endoscopy revealed duodenal stenosis. We therefore performed endoscopic resection with an insulated-tip knife because of the history of prior operations, fasting problems after operations, and respiratory infections. Seven days later, scar formation was noted on the second portion of the duodenum, the scope passed well at the excision site, and no retained food material was noted on the follow-up endoscopy. After the procedure, the patient's abdominal distention and repetitive vomiting subsided, and she was discharged with the ability to eat eat an age-appropriate normal diet. There were no specifi c symptoms or other complications for 1 year after the procedure.

Duodenal web in an adult presenting with acute pancreatitis and acquired megaduodenum: Report of a case

Duodenal webs are a cause of intestinal atresia in infants and surgical repair is the established treatment of choice. However, the late-onset postoperative complications have not been adequately studied, especially in adults who have undergone surgical interventions as infants. This report describes the case of a 65-year-old female patient who presented with consecutive episodes of acute pancreatitis and a history of duodenal atresia repaired by a gastrojejunostomy in early infancy. Imaging studies revealed the presence of megaduodenum and suggested the possibility of impacted stones at the ampulla of Vater. An intact duodenal web at the level of papilla of Vater was revealed during surgery. Excision of the web, tapering of the duodenum and duodenojejunostomy was performed to relieve the obstructive cause of pancreatitis and to restore the intestinal continuity. At the 1-year follow-up, the patient is free of any symptoms, has no diet restrictions, and has increased her body weight as well.

Duodenal stenosis in a child

We present a case of incomplete duodenal obstruction having a delayed presentation, making diagnosis and early intervention more challenging. Failure of recanalization of the duodenal lumen during the eighth to tenth week of gestation, results in duodenal atresia. Incomplete recanalization can lead to duodenal stenosis or the presence of a duodenal web. In the absence of other serious anomalies or prematurity, the overall survival for duodenal stenosis or atresia is nearly 100%.