Simultaneous duodenal stenosis and duodenal web in a newborn

Abstract

Failure of duodenal recanalization results in a spectrum of proximal bowel obstruction from stenosis to atresia. Associations between congenital duodenal obstruction and other congenital anomalies have been well documented although the coincidence of duodenal stenosis and duodenal web is incredibly rare, posing a unique diagnostic challenge. We report a case of a full-term 4-day-old female child presented with forceful, bilious emesis and poor oral intake with decreased frequency of urination, and stooling whose initial abdominal radiograph showed several loops of gas-filled bowel in the distal stomach and proximal duodenum mimicking the classic “double-bubble” sign. An upper gastrointestinal barium contrast study revealed distention of the duodenal bulb with an abrupt narrowing and subsequent dilation at the second portion of the duodenum raising the suggestion of multiple duodenal obstructions. Ladd’s procedure was performed, and the stenotic and webbed segments were bypassed with a Kimura diamond-shaped duodenoduodenostomy.

Congenital duodenal obstruction: Ten-year results of a tertiary center

“…Other anomalies are anorectal malformations, esophageal atresia, cardiac defects, urinary and extremity anomalies (3)(4)(5)(6). However, these anomalies have no effect on survival (8). The most common additional anomaly in our study was Down Syndrome; no additional anomaly was found in any of the patients that we lost due to sepsis.…”

“…The most common additional anomaly in our study was Down Syndrome; no additional anomaly was found in any of the patients that we lost due to sepsis. A mortality rate of 9% (6) in a study and 22.5% in another study were reported (8). The most common cause of mortality was sepsis and cardiac pathologies (6).…”

“…Furthermore, not comparing open surgery and laparoscopic method was accepted as a shortcoming of this study. Duodenal obstructions have been reported to be associated with other congenital anomalies with a probability of 38-55% (13) The most common additional anomaly is Down Syndrome (8). Other anomalies are anorectal malformations, esophageal atresia, cardiac defects, urinary and extremity anomalies (3)(4)(5)(6).…”

Duodenal Stenosis: A Diagnostic Challenge in a Neonate With Poor Weight Gain

“…Intrinsic congenital duodenal obstruction refers to duodenal atresia, duodenal stenosis, and duodenal webs. The proposed etiology of intrinsic duodenal obstruction has been stated as failure of the duodenal lumen to recanalize during fetal development, which occurs at roughly 8-10 weeks in utero [4]. Duodenal atresia is the most common cause of congenital duodenal obstruction, with an incidence of roughly 1 in 10,000 live [5].…”

Pediatric Stomach and Duodenal Imaging

“…CT and MRI are usually not necessary and indicated only in cases where there is a diagnostic dilemma 12,13 (►Fig. 5 and 6).…”