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Chen KQ, Jiang WQ, Li XR. Diagnostic value of upper gastrointestinal imaging for duodenal webbing in adults: A case report. World J Clin Cases 2025; 13:101443. [PMID: 40291583 PMCID: PMC11718561 DOI: 10.12998/wjcc.v13.i12.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Revised: 12/10/2024] [Accepted: 12/18/2024] [Indexed: 01/07/2025] Open
Abstract
BACKGROUND Duodenal web is a rare congenital malformation, exceedingly uncommon in adults, and often misdiagnosed due to the subtle imaging features. CASE SUMMARY By analyzing the clinical diagnosis process and various imaging findings of a patient from our institution, this case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs, outlines its typical radiographic features, and provides a literature review on the etiology, clinical presentation, and management of this condition. CONCLUSION This case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs.
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Affiliation(s)
- Kang-Quan Chen
- Department of Radiology, General Hospital of Southern Theater Command, Guangzhou 510010, Guangdong Province, China
| | - Wen-Qian Jiang
- Department of Radiology, General Hospital of Southern Theater Command, Guangzhou 510010, Guangdong Province, China
| | - Xiao-Rong Li
- Department of Radiology, General Hospital of Southern Theater Command, Guangzhou 510010, Guangdong Province, China
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Tjaden NEB, Acord M, Minturn J, Allukian M, Mamula P. Thirty-two-month-old with multiple duodenal webs diagnosed after failed gastrojejunostomy exchange successfully treated with combination endoscopic therapy. JPGN REPORTS 2024; 5:483-487. [PMID: 39610424 PMCID: PMC11600358 DOI: 10.1002/jpr3.12107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/02/2024] [Accepted: 05/10/2024] [Indexed: 11/30/2024]
Abstract
Intestinal 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.
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Affiliation(s)
- Naomi E. B. Tjaden
- Gastroenterology, Hepatology and NutritionChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Michael Acord
- Interventional RadiologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Jane Minturn
- OncologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Myron Allukian
- Pediatric General, Thoracic and Fetal SurgeryChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Petar Mamula
- Gastroenterology, Hepatology and NutritionChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
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Marakhouski K, Malyshka E, Nikalayeva K, Valiok L, Pataleta A, Sanfirau K, Svirsky A, Averin V. Balloon dilation of congenital perforated duodenal web in newborns: Evaluation of short and long-term results. World J Gastrointest Endosc 2024; 16:343-349. [PMID: 38946850 PMCID: PMC11212519 DOI: 10.4253/wjge.v16.i6.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/23/2024] [Accepted: 04/29/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND 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. AIM To present our experience of balloon dilatation of a perforated duodenal membrane in newborns with ICDO. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Kirill Marakhouski
- Division of Diagnostic, Republican Scientific and Practical Centre of Paediatric Surgery, Minsk 220113, Belarus
| | - Elena Malyshka
- Department of Newborn Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Katsiaryna Nikalayeva
- Department of Pediatric Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Larysa Valiok
- Department of Newborn Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Aleh Pataleta
- Division of Diagnostic, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Kiryl Sanfirau
- Division of Diagnostic, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Aliaksandr Svirsky
- Department of Pediatric Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Vasily Averin
- Academic Chair of Pediatric Surgery, Belarusian State Medical University, Minsk 220116, Belarus
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Sun S, Zheng S, Wu J, Tang Z, Shen C, Chen G, Dong K. Clinical application of endoscopic diaphragmotomy and dilation in a congenital duodenal diaphragm. Front Pediatr 2024; 12:1298748. [PMID: 38445081 PMCID: PMC10912644 DOI: 10.3389/fped.2024.1298748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
Background A congenital duodenal diaphragm (CDD) is a rare cause of duodenal obstruction in infants and children. The traditional approach to treatment has been surgical intervention either with excision and duodenoplasty or with bypass through a duodenoduodenostomy, which is invasive and carries the risk of anastomotic leakage. Aims To summarize the key points of differential diagnosis and treatment of a CDD under gastroscopy and to evaluate its efficacy and safety. Methods The clinical data of patients with a duodenal obstruction diagnosed and treated by gastroscopy in our hospital between January 2019 and December 2022 were retrospectively analyzed. The gastroscopic features of the CDD were summarized. The clinical outcomes of patients with CDD treated by gastroscopy were collected and investigated. Results A total of 13 children with a duodenal obstruction underwent a gastroscopic examination and/or treatment, and of these, 10 were diagnosed as having a CDD and 3 were finally diagnosed as having an annular pancreas. A dome-shaped structure during inspiration (9/10) and a guidewire that could be inserted through the opening into the distal lumen (6/10) were the gastroscopic features of the CDD, while the annular pancreas had none of these features. The 10 patients, 4 men and 6 women with the CDD, were treated through endoscopic diaphragmotomy and dilation. The age and weight at operation was 15 days to 7 years (M: 2.25 years) and 2.85-22 kg (M: 13.6 kg), respectively. A total of 11 endoscopic operations were performed in the 10 patients. The time of single operation was 15-55 min (M: 38 min). The patients did not experience complications such as bleeding, pneumoperitoneum, and duodenal papilla injury during the operation. Feeding was started 12-24 h after surgery, and the patients were discharged 2-10 days (M: 7 days) postoperatively. The patients were followed up for 3-36 months (M: 17 months), and none of them had a recurrence of vomiting. However, three showed a recurrence of stenosis in upper gastrointestinal imaging, one of whom underwent a partial diaphragm resection again 2 months after the primary treatment. Conclusions A CDD can be confirmed by endoscopy based on its characteristic features. Endoscopic diaphragmotomy and balloon dilation are safe and effective, which can be a new option for minimally invasive treatment of a CDD.
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Affiliation(s)
- Song Sun
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Shan Zheng
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Jie Wu
- Gastroenterology Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Zifei Tang
- Gastroenterology Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Chun Shen
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Gong Chen
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Kuiran Dong
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
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Kasimi A, Nasri S, Haddar L, Samet M, Azzouzi DE, Babakhouya A, Aichouni N, Kamaoui I, Skiker I. Delayed presentation of duodenal diaphragm and annular pancreas in a 10-year-old girl: Case report. Radiol Case Rep 2024; 19:264-267. [PMID: 38028306 PMCID: PMC10654427 DOI: 10.1016/j.radcr.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 09/05/2023] [Accepted: 10/01/2023] [Indexed: 12/01/2023] Open
Abstract
Congenital duodenal obstruction is a common cause of bowel obstruction. It is relatively easy to diagnose in the neonatal period. However, if the obstruction is due to a duodenal diaphragm, diagnosis may be delayed until later in infancy or even adulthood, depending on the size of the aperture in the diaphragm. Congenital duodenal obstruction may be associated with other gastrointestinal and biliary anomalies. The association of a duodenal diaphragm and a partial annular pancreas is a rare clinical entity. We present an unusual case of late presentation of duodenal diaphragm with partial annular pancreas in a 10-year-old girl with a 3-month history of abdominal distension and vomiting. The plain abdominal X-ray showed the classic picture of a double bubble. The CT images showed narrowing of the third duodenal portion and dilatation of the stomach and duodenum. The pancreatic tissue incompletely surrounded the second part of the duodenum. Intraoperatively, both the duodenal diaphragm and the partial annular pancreas were confirmed. Excision of the diaphragm and duodenoplasty were performed. A duodenal diaphragm should be suspected in patients with a history of abdominal distension and vomiting, even in late childhood. Associated gastrointestinal and biliary anomalies should always be excluded.
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Affiliation(s)
- Asmae Kasimi
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Siham Nasri
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Leila Haddar
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Mahdi Samet
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Driss El Azzouzi
- Department of Pediatric Surgery, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Abdeladim Babakhouya
- Department of Pediatrics, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Narjisse Aichouni
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Imane Kamaoui
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Imane Skiker
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
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Ekram K, Razawi F, Jalal SN, Sultani MN, Wali AW, Sediqi MS, Hamdard AG, Hemat M, Sahibzada MM. Congenital duodenal web causing partial obstruction with recurrent vomiting and abdominal distention in a toddler boy: a case report. J Med Case Rep 2023; 17:507. [PMID: 37996900 PMCID: PMC10668464 DOI: 10.1186/s13256-023-04179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/14/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The 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 PRESENTATION A 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. CONCLUSION Congenital 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.
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Affiliation(s)
- Khesrow Ekram
- Department of Pediatrics, Maiwand Teaching Hospital, Kabul University of Medical Sciences, 1st District, Jada-e-Maiwand, 1001, Kabul, Afghanistan.
| | - Farida Razawi
- Department of Pediatric Surgery, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Sayed Najmuddin Jalal
- Department of Pediatrics, Maiwand Teaching Hospital, Kabul University of Medical Sciences, 1st District, Jada-e-Maiwand, 1001, Kabul, Afghanistan
| | - Mohammad Nader Sultani
- Department of Pediatric Surgery, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Abdul Wali Wali
- Department of Pediatrics, Maiwand Teaching Hospital, Kabul University of Medical Sciences, 1st District, Jada-e-Maiwand, 1001, Kabul, Afghanistan
| | - Mohammad Sharif Sediqi
- Department of Pediatrics, Maiwand Teaching Hospital, Kabul University of Medical Sciences, 1st District, Jada-e-Maiwand, 1001, Kabul, Afghanistan
| | - Abdul Ghafar Hamdard
- Department of Dermatology, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Massoud Hemat
- Department of Pediatric Surgery, Kabul University of Medical Sciences, Kabul, Afghanistan
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Baran JV, Brown JM, Rivera-Nieves D, Karjoo S, Smithers CJ, Wilsey MJ. Avoiding Surgery: Endoscopic Treatment of Congenital Duodenal Stenosis. JPGN REPORTS 2023; 4:e347. [PMID: 38034463 PMCID: PMC10684216 DOI: 10.1097/pg9.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/24/2023] [Indexed: 12/02/2023]
Abstract
Duodenal stenosis is a rare congenital anomaly that is typically treated surgically, although endoscopic incisional therapy (EIT) and balloon dilation are minimally invasive alternatives. We present a case of a 15-month-old male with vomiting and difficulty tolerating solid food due to severe congenital duodenal stenosis. The patient underwent EIT and serial duodenal dilation to a diameter of 20 mm, which resulted in significant symptom improvement. Intralesional corticosteroid injection (ISI) was administered to help prevent the duodenal septum from restricturing. The combination of EIT, balloon dilation, and ISI was successful in treating the patient's congenital duodenal stenosis and avoided the need for surgery. However, further studies are required to confirm the efficacy of this treatment approach in this patient population. This report highlights the potential of this minimally invasive approach as an alternative to surgical intervention in the management of congenital duodenal stenosis.
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Affiliation(s)
- Jessica V. Baran
- From the Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Jerry M. Brown
- From the Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Desiree Rivera-Nieves
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Sara Karjoo
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - C. Jason Smithers
- Department of Surgery, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Michael J. Wilsey
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
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Abdulaziz GM, Mohamed KM, Zilai AH, Attieh AI, Alhammad EA, Akkam AY. An Unusual Diagnosis for an Infant Presenting with Olive-Shaped Abdominal Mass. Case Rep Pediatr 2023; 2023:6924037. [PMID: 37790919 PMCID: PMC10545470 DOI: 10.1155/2023/6924037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/23/2023] [Accepted: 08/18/2023] [Indexed: 10/05/2023] Open
Abstract
A 3-month-old male infant was bought to the emergency department with almost 3 weeks of projectile, bilious emesis after each feed. On presentation, he was cachectic and severely dehydrated and had a palpable olive in the epigastric region. Hypertrophic pyloric stenosis was excluded by abdominal ultrasound. The barium meal demonstrated a massively distended stomach, absence of distal gas, and triple bubble sign. Given the radiological findings, the patient underwent an emergency exploratory laparotomy and a congenital duodenal web (CDW) was discovered. While the clinical picture suggested the diagnosis of HPS, barium meal eventually revealed congenital duodenal web. To our knowledge, no other cases of palpable olive mass as the presenting sign of proximal bowel obstruction have been published.
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Affiliation(s)
| | | | - Ayat Hassan Zilai
- Pediatric Emergency Department, King Saud Medical City, Riyadh, Saudi Arabia
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Alimadadi M, Ghanbari R, Yousefi M, Sadani S. Duodenal Web in an Elderly Patient with Abdominal Discomfort and Vomiting: A Rare Case. ARCHIVES OF IRANIAN MEDICINE 2023; 26:455-458. [PMID: 38301108 PMCID: PMC10685735 DOI: 10.34172/aim.2023.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/25/2023] [Indexed: 02/03/2024]
Abstract
Duodenal web is complete or incomplete obstruction of the duodenum due to a membranous web or intraluminal diverticulum. This abnormality is one of the main causes of intestinal obstruction in children. The symptoms of this disease may rarely appear in older age and cause gastric outlet obstruction in adults. In the present paper, we report a 69-year-old male patient with heartburn, abdominal discomfort, frequent non-bilious, non-bloody vomiting for the past 6 months. Furthermore, the patient had experienced a weight loss of 12 kg during this period. He had been taking aspirin daily for years due to his ischemic heart disease. After performing contrast-enhanced CT imaging, esophagogastroduodenoscopy and barium meal examination, the patient was diagnosed to suffer from duodenal web. Since surgery is currently the mainstay of treatment in the management of this disease, the patient finally underwent a gastrojejunostomy.
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Affiliation(s)
- Mehdi Alimadadi
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Reza Ghanbari
- Gene Therapy Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohanna Yousefi
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Somayeh Sadani
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
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Wang X, Lin K, Liu H, Hu Z, Ye G, Sheng Q, Lv Z. Endoscopic Balloon Dilatation-Based Membrane Resection for Membranous Duodenal Stenosis: A Feasibility and Safety Study (With Video). J Pediatr Gastroenterol Nutr 2023; 77:e36-e41. [PMID: 37285839 PMCID: PMC10348657 DOI: 10.1097/mpg.0000000000003848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Surgery is generally considered as the first-line therapy for membranous duodenal stenosis (MDS) in children. However, abdominal surgery leaves permanent scars and may even cause intestinal adhesion. Therefore, an effective, safe, and minimally invasive method is urgently needed. This study aimed to evaluate the safety, efficacy, and feasibility of endoscopic balloon dilatation-based membrane resection (EBD-MR) to treat MDS in children. METHODS We retrospectively reviewed patients with MDS treated with EBD-MR in Shanghai Children's Hospital from May 2016 to August 2021. Primary study outcome was clinical success, defined as weight gain and complete remission of vomiting, without the need for repeat endoscopic or surgical intervention during follow-up. Secondary outcomes included technical success, diameter changes of the membrane opening, and adverse events. RESULTS Nineteen children (9 females, mean age 14.5 ± 11.2 months) received endoscopic treatment for MDS, and clinical success was achieved in 18 of 19 patients (94.7%). No bleeding, perforation, and jaundice occurred. Diameters of the membrane opening increased from 2.97 ± 2.87 mm to 9.78 ± 1.27 mm after the treatment, symptoms of vomiting did not reappear during 10-73 months of follow-up, and body mass index of the children increased from 14.9 ± 2.2 kg/m 2 (pre-operation) to 16.2 ± 3.7 kg/m 2 (6 months after operation). One patient required surgical revision because of existence of a second web; three patients received 2-3 sessions of endoscopic treatment to obtain the final remission. CONCLUSIONS The EBD-MR technique is safe, effective, and feasible for MDS, which provided an excellent alternative to surgical management for the disease in pediatric patients.
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Affiliation(s)
- Xing Wang
- From the Department of Digestive Endoscopy Center, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Kai Lin
- From the Department of Digestive Endoscopy Center, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Haifeng Liu
- From the Department of Digestive Endoscopy Center, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhihong Hu
- From the Department of Digestive Endoscopy Center, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guogang Ye
- the Department of General Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qingfeng Sheng
- the Department of General Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhibao Lv
- the Department of General Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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11
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Chew K, Bellemare S, Kumar A. Packed with pills - obstructing duodenal web in the setting of intestinal malrotation: A case report. World J Gastrointest Endosc 2023; 15:77-83. [PMID: 36925649 PMCID: PMC10011889 DOI: 10.4253/wjge.v15.i2.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/02/2023] [Accepted: 01/16/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND The incidence of intestinal malrotation in adults has been reported to only be about 0.2%. Duodenal web as a cause of intestinal obstruction is rare, with an incidence of about 1:20000-1:40000. Furthermore, when described, these conditions are usually seen in early life and very infrequently in adulthood.
CASE SUMMARY We report a case of a middle-aged woman with intestinal malrotation who presented with a three-month history of right-sided abdominal pain, early satiety, and a 22-pound weight loss. Patient underwent an esophagogastroduodenoscopy, which demonstrated numerous retained pills in a deformed first portion of the duodenum, concerning for a partial gastric outlet obstruction. An upper gastrointestinal series showed marked distention of the proximal duodenum with retained debris and the presence of a windsock sign, increasing the suspicion of a duodenal web. The patient subsequently underwent surgical intervention where a duodenal web with two lumens was noted and resected, opening the duodenum. There were over 150 pill capsules that were removed. The patient is doing well after this intervention.
CONCLUSION Both intestinal malrotation and duodenal webs are infrequently encountered in the adult population. These pathologies can also present with nonspecific abdominal symptoms such as chronic abdominal pain and nausea. Hence, providers might not consider these pathologies in the differential for patients who present with vague symptoms which can lead to delay in management and increased mortality and morbidity.
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Affiliation(s)
- Kimberline Chew
- Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, United States
| | - Sarah Bellemare
- Division of Hepato-biliary Surgery, Montefiore Medical Center, Bronx, NY 10467, United States
| | - Akash Kumar
- Division of Gastroenterology, Montefiore Medical Center, Bronx, NY 10467, United States
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12
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Kueppers J, Muensterer O. Innovative Endoscopic Management of a Duodenal Web Using Balloon Dilatation and a Gastrojejunal Tube in an Infant with Complex Esophageal Atresia. J Laparoendosc Adv Surg Tech A 2022; 32:1269-1271. [PMID: 36445752 DOI: 10.1089/lap.2022.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Julia Kueppers
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Oliver Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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13
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Morris G, Kennedy A. Small Bowel Congenital Anomalies. Surg Clin North Am 2022; 102:821-835. [DOI: 10.1016/j.suc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Tang YP, Wei XX, Fu XL, Xue N, Xu JJ. Successful treatment with endoscopic radial incision for congenital duodenal membranous stenosis in three children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Jangid MK, Ahmad R, Pandre S. Delayed presentation of a congenital duodenal web managed successfully with incision of web. BMJ Case Rep 2020; 13:13/12/e237307. [PMID: 33370983 PMCID: PMC7757442 DOI: 10.1136/bcr-2020-237307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
One of the causes of congenital incomplete duodenal obstruction is the presence of congenital duodenal web with fenestration. This condition requires a high index of suspicion for an early and accurate diagnosis. We present an unusual presentation of duodenal web in a 6-year-old girl who presented with a 3-year history of cyclical and seasonal vomiting and abdominal pain. The diagnosis of congenital duodenal web with fenestration was made on contrast study and endoscopy and was treated surgically by incision of the web.
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Affiliation(s)
- Mahendra Kumar Jangid
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Reyaz Ahmad
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sujeet Pandre
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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16
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Wu L, Jia G, Hu Y, Zhu L, Wang S. A rare case of duodenal diaphragm in an adult during ERCP treatment for choledocholithiasis. BMC Surg 2020; 20:273. [PMID: 33160346 PMCID: PMC7648286 DOI: 10.1186/s12893-020-00934-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Duodenal Diaphragm in adults is very uncommon, caused by congenital and acquired changes. It is reported that acquired duodenal diaphragm is related to the long-term use of nonsteroidal anti-inflammatory drugs. Case summary We report an adult presentation of duodenal diaphragm in a 77-year-old woman, suffered from acute cholangitis and choledocholithiasis. She was performed endoscopic retrograde cholangiopancreatography (ERCP) procedure to remove the stone in common bile duct (CBD). After the stenosis ring dilated by endoscopic balloon dilatation, ERCP procedure was applied, and the CBD stone was removed successfully. Conclusion Duodenal diaphragm is difficult to diagnose in clinic. Although the patient in this case had relatively mild symptoms of incomplete upper hemi-abdominal obstruction, these symptoms could be obscured by the emergency acute upper abdominal pain with fever as clinical manifestations of acute cholangitis.
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Affiliation(s)
- Liying Wu
- Department of Gastroenterology, Huaibei People's Hospital, No. 66 Huaihai West Road, Huaibei, 235000, Anhui, People's Republic of China.
| | - Guofa Jia
- Department of Gastroenterology, Huaibei People's Hospital, No. 66 Huaihai West Road, Huaibei, 235000, Anhui, People's Republic of China
| | - Yiheng Hu
- Department of Gastroenterology, Huaibei People's Hospital, No. 66 Huaihai West Road, Huaibei, 235000, Anhui, People's Republic of China
| | - Liangsong Zhu
- Department of Gastroenterology, Huaibei People's Hospital, No. 66 Huaihai West Road, Huaibei, 235000, Anhui, People's Republic of China
| | - Shuhai Wang
- Department of Gastroenterology, Huaibei People's Hospital, No. 66 Huaihai West Road, Huaibei, 235000, Anhui, People's Republic of China
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17
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Maddineni S, Stringel G, Rozenblit G, Meshekow J, McCabe S. Single balloon dilation of symptomatic duodenal web: Long-term success. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Wani SA, Rashid KA, Saxena K, Khan M. Atypical presentation of concurrent duodenal web and malrotation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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19
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Muthuvel G, Bartlett MG, Absah I. Case 2: Chronic Feeding Intolerance in a 9-year-old Boy with a Complex Medical History. Pediatr Rev 2020; 41:200-202. [PMID: 32238549 DOI: 10.1542/pir.2017-0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Mark G Bartlett
- Department of Pediatric and Adolescent Medicine and.,Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Imad Absah
- Department of Pediatric and Adolescent Medicine and.,Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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20
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Elrouby A, Koraitim A. Fatal Course of a Male Newborn with Double Duodenal Atresia. European J Pediatr Surg Rep 2020; 8:e7-e9. [PMID: 32042546 PMCID: PMC7007303 DOI: 10.1055/s-0039-3400488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 08/05/2019] [Indexed: 11/26/2022] Open
Abstract
Multiple point duodenal atresia is an extremely rare condition with atretic segments in either two or three sites of the duodenum. We report a newborn male patient who presented to our institution with bilious vomiting, nonpassage of meconium, mild abdominal distension, and a palpable epigastric abdominal mass ∼1 × 1 cm. A faint double bubble was found on abdominal X-ray. On exploratory laparotomy, a duodenal cyst due to double duodenal atresia was found and a typical diamond-shaped duodeno-duodenostomy was created. A postoperative contrast study revealed passage of the contrast media into distal intestine. However, the patient died 2 weeks later due to uncontrolled sepsis and pneumonia. Despite the fact that multiple-point duodenal atresia is a rare condition, it should be considered as a differential diagnosis to avoid missed pathology.
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Affiliation(s)
- Ahmed Elrouby
- Department of Pediatric Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Koraitim
- Department of Pediatric Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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21
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Goring J, Isoldi S, Sharma S, Torroni F, Marven S, De Angelis P, Thomson M. Natural orifice endoluminal technique (NOEL) for the management of congenital duodenal membranes. J Pediatr Surg 2020; 55:282-285. [PMID: 31839373 DOI: 10.1016/j.jpedsurg.2019.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/26/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Congenital Partial Duodenal Obstruction (CPDO) caused by membranes/webs/diaphragms has traditionally been managed by open or laparoscopic duodenoduodenostomy or duodenojejunostomy. We report a two center case series where Natural Orifice Endoluminal technique (NOEL) was used to treat children with CPDO. METHODS A retrospective case series was evaluated. Data collected included the duration of procedure, postoperative complications, length of stay, and need for further procedures. RESULTS Fifteen patients were treated over a 10 year period by NOEL technique for late presenting CPDO. Four patients were managed at Sheffield Children's Hospital (Center A, UK), and 11 patients were managed in Bambino Gesù Hospital of Rome (Center B, Italy). 20% of the patients had more than one duodenal obstructing membrane. Both balloon dilatation and membrane incision techniques were used. Median follow up was 23 months (range 2-69) in Center A and 18 months (range 7-58) in Center B. 60% of patients were successfully treated with 1 NOEL procedure. 20% required 2 or 3 procedures to achieve long term luminal patency. 20% required surgery after NOEL failed to treat the partial obstruction definitively. One patient in Center A required radiological drainage of a retroperitoneal collection following perforation during NOEL. CONCLUSION NOEL technique is feasible and effective in selected children with CPDO. Both balloon dilatation and incision techniques can be used. Care must be taken to rule out a second distal obstruction. We would recommend that all infants and children with CPDO owing to a fenestrated membrane should be considered for NOEL. TYPE OF STUDY Case series. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Sara Isoldi
- Bambino Gesù Children's Hospital, Rome, Italy
| | - Shishu Sharma
- Sheffield Children's Hospital, Sheffield, United Kingdom
| | | | - Sean Marven
- Sheffield Children's Hospital, Sheffield, United Kingdom
| | | | - Mike Thomson
- Sheffield Children's Hospital, Sheffield, United Kingdom.
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22
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Gulizia D, Zibari N, Evangelista M. Hematemesis in a 5-Month-Old Girl: A Tale of Double Whammy. Clin Pediatr (Phila) 2018; 57:615-617. [PMID: 28905643 DOI: 10.1177/0009922817729485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dustin Gulizia
- 1 The University of Texas Health Science Center McGovern Medical School, Houston, TX, USA
| | - Nujeen Zibari
- 1 The University of Texas Health Science Center McGovern Medical School, Houston, TX, USA
| | - Monaliza Evangelista
- 1 The University of Texas Health Science Center McGovern Medical School, Houston, TX, USA
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23
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Singh AP, Tanger R, Barolia DK, Gupta AK, Mehra SK. Multiple Foreign bodies entrapped at Duodenal Web. APSP J Case Rep 2017; 8:22. [PMID: 28540193 PMCID: PMC5423891 DOI: 10.21699/ajcr.v8i3.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/29/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Aditya Pratap Singh
- Department of Pediatric Surgery, SMS Medical College Jaipur, Rajasthan, India
| | - Ramesh Tanger
- Department of Pediatric Surgery, SMS Medical College Jaipur, Rajasthan, India
| | | | - Arun Kumar Gupta
- Department of Pediatric Surgery, SMS Medical College Jaipur, Rajasthan, India
| | - Sunil Kumar Mehra
- Department of Pediatric Surgery, SMS Medical College Jaipur, Rajasthan, India
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24
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Erickson J, Retrouvey M, Rush J, Trace AP. Simultaneous duodenal stenosis and duodenal web in a newborn. Radiol Case Rep 2016; 11:444-446. [PMID: 27920877 PMCID: PMC5128381 DOI: 10.1016/j.radcr.2016.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/23/2016] [Accepted: 08/28/2016] [Indexed: 01/01/2023] Open
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.
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Affiliation(s)
- James Erickson
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Michele Retrouvey
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
| | - Jennifer Rush
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
| | - Anthony P Trace
- Department of Radiology, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, USA
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25
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Upadhyaya VD, Kumar B, Gupta A, Naranje K, Singh A. Jejunal Windsock Deformity: A Rare Cause of Incomplete Neonatal Intestinal Obstruction. J Neonatal Surg 2016; 5:57. [PMID: 27896165 PMCID: PMC5117280 DOI: 10.21699/jns.v5i4.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/28/2016] [Indexed: 11/21/2022] Open
Abstract
Incomplete intestinal obstruction due to windsock web of the jejunum is uncommonly noticed in neonates. We present a male neonate, prenatally suspected case of proximal bowel obstruction, who was found to have features of incomplete intestinal obstruction due to windsock deformity in jejunum. The difficulty in the diagnosis and management is discussed along with relevant literature review.
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Affiliation(s)
| | - Basant Kumar
- Department of Pediatric Surgery, SGPGIMS, Lucknow India
| | | | | | - Anita Singh
- Department of Neonatology, SGPGIMS, Lucknow India
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26
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Two Cases of Intraluminal "Windsock" Diverticula Resulting in Partial Duodenal Obstruction. ACG Case Rep J 2016; 3:e135. [PMID: 27807587 PMCID: PMC5062679 DOI: 10.14309/crj.2016.108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/31/2016] [Indexed: 11/29/2022] Open
Abstract
An intraluminal duodenal diverticulum (IDD) is a rare congenital anomaly that is the result of incomplete recanalization of the embryologic foregut leaving a fenestrated membrane within the lumen of the duodenum. Years of peristalsis acting on the membrane result in the formation of a diverticulum. Most patients are asymptomatic, while some may have abdominal pain, bloating, or fullness. Rare complications include gastrointestinal bleeding, obstruction, pancreatitis, and cholangitis. We present 2 cases with endoscopic findings consistent with partially obstructing symptomatic IDD.
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27
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Angotti R, Molinaro F, Cobellis G, Noviello C, Bocchi C, Ferrara F, Bindi E, Messina M. Persistent Nonbilious Vomiting in a Child: Possible Duodenal Webbing. Clin Endosc 2016; 50:191-196. [PMID: 27732773 PMCID: PMC5398358 DOI: 10.5946/ce.2016.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/14/2016] [Accepted: 09/03/2016] [Indexed: 01/30/2023] Open
Abstract
An association between malrotation and congenital duodenal webbing is rare. We present our experience with four patients at two centers, and a review of published reports. There are currently 94 reported cases of duodenal pathology associated with malrotation. However, only 15 of the 94 cases (15.9%) include patients with malrotation and a duodenal web. We suggest that nonbilious vomiting in a child must prompt the surgeon to consider duodenal pathology even in the presence of malrotation.
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Affiliation(s)
- Rossella Angotti
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Francesco Molinaro
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Academic Salesi Children Hospital, Marche Polytechnic University, Ancona, Italy
| | - Carmine Noviello
- Pediatric Surgery Unit, Academic Salesi Children Hospital, Marche Polytechnic University, Ancona, Italy
| | - Caterina Bocchi
- Section of Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Francesco Ferrara
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Edoardo Bindi
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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28
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Abstract
The small intestine is a complex organ system that is vital to the life of the individual. There are a number of congenital anomalies that occur and present most commonly in infancy; however, some may not present until adulthood. Most congenital anomalies of the small intestine will present with obstructive symptoms while some may present with vomiting, abdominal pain, and/or gastrointestinal bleeding. Various radiologic procedures can aid in the diagnosis of these lesions that vary depending on the particular anomaly. Definitive therapy for these congenial anomalies is surgical, and in some cases, surgery needs to be performed urgently. The overall prognosis of congenital anomalies of the small intestine is very good and has improved with improved medical management and the advent of newer surgical modalities. The congenital anomalies of the small intestine reviewed in this article include malrotation, Meckel's diverticulum, duodenal web, duodenal atresia, jejunoileal atresia, and duplications.
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Affiliation(s)
- Grant Morris
- Department of Pediatrics, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Alfred Kennedy
- Department of Pediatric Surgery, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - William Cochran
- Department of Pediatric Gastroenterology, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA.
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29
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Poddar U, Jain V, Yachha SK, Srivastava A. Congenital duodenal web: successful management with endoscopic dilatation. Endosc Int Open 2016; 4:E238-41. [PMID: 27004237 PMCID: PMC4798844 DOI: 10.1055/s-0041-110955] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/07/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Congenital duodenal web (CDW) is an uncommon cause of duodenal obstruction and endoscopic balloon dilatation has been reported in just eight pediatric cases to date. Here we are reporting three cases of CDW managed successfully with balloon dilatation. CASES AND METHODS In 2014 we diagnosed three cases of CDW on the basis of typical radiological and endoscopic findings. Endoscopic balloon dilatation was done under conscious sedation with a through-the-scope controlled radial expansion (CRE) balloon. RESULTS All three children presented late (median age 8 [range 2 - 9] years) with bilious vomiting, upper abdominal distension, and failure to thrive. One of them had associated Down syndrome and another had horseshoe kidney. In all cases, CDW was observed in the second part of the duodenum beyond the ampulla, causing partial duodenal obstruction. After repeated endoscopic dilatation (2 - 4 sessions), all three patients became asymptomatic. None of the patients experienced complications after balloon dilatation. CONCLUSIONS Duodenal diaphragm should be suspected in patients with abdominal distension with bilious vomiting, even in relatively older children. Endoscopic balloon dilatation is a simple and effective method of treating this condition.
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Affiliation(s)
- Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India,Corresponding author: Ujjal Poddar, MD, DNB, DM Department of Pediatric GastroenterologySGPGIMS, Lucknow-226014India+91-522-249-4418+91-522-266-8017
| | - Vikas Jain
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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30
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31
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Abstract
When performing an open duodenal web excision, it is helpful to identify the web using a nasogastric tube because it is often difficult to determine where the web origin is located when looking at the serosal side of the bowel. However, it may be challenging to navigate the nasogastric tube to the web during laparoscopy. We present a novel technique that utilizes intraoperative endoscopy to precisely identify the location of the duodenal web, facilitating laparoscopic excision. Intraoperative endoscopy was implemented in the case of a 3-month-old boy undergoing laparoscopic excision of a duodenal web. With endoscopic visualization and transillumination, the duodenal web was precisely identified and excised laparoscopically. A supplemental video of the case presentation and technique is provided in the online version of this manuscript (Supplemental Digital Content 1, http://links.lww.com/SLE/A134). The procedure was completed successfully and the patient did well postoperatively. Flexible endoscopy is a useful adjunct for duodenal web localization during laparoscopy, improving on the previous method of estimating the location based on a change in duodenal caliber.
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32
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Successful Endoscopic Needle-Knife Catheter Membranotomy of a Congenital Duodenal Web. J Pediatr Gastroenterol Nutr 2015; 61:e22-3. [PMID: 26505961 DOI: 10.1097/mpg.0000000000000323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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33
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Duodenal web resection via hybrid natural orifice transluminal endoscopic surgery (NOTES). JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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34
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Eksarko P, Nazir S, Kessler E, LeBlanc P, Zeidman M, Asarian AP, Xiao P, Pappas PJ. Duodenal web associated with malrotation and review of literature. J Surg Case Rep 2013; 2013:rjt110. [PMID: 24968440 PMCID: PMC3887994 DOI: 10.1093/jscr/rjt110] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | | | - Philip Xiao
- The Brooklyn Hospital Center, Brooklyn, NY, USA
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35
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Heller MT, Haarer KA, Itri JN, Sun X. Duodenum: MDCT of acute conditions. Clin Radiol 2013; 69:e48-55. [PMID: 24239275 DOI: 10.1016/j.crad.2013.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/14/2013] [Accepted: 09/20/2013] [Indexed: 12/26/2022]
Abstract
Multidetector computed tomography (MDCT) is the technique of choice for evaluating patients with acute abdominal pain. As the jejunum, ileum, and colon comprise the majority of the gastrointestinal tract, radiologists may potentially neglect the duodenum. However, the duodenum is a complex structure that can be affected by both intraperitoneal and extraperitoneal processes due to its central location and proximity to numerous upper abdominal structures. In this review, the MDCT findings of various congenital, inflammatory, traumatic, infectious, vascular, and miscellaneous conditions that affect the duodenum are discussed.
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Affiliation(s)
- M T Heller
- Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - K A Haarer
- Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J N Itri
- Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - X Sun
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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36
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Solomon AB, Sockolow RE. Acute onset vomiting in a toddler: an uncommon presentation of duodenal stenosis. Clin Pediatr (Phila) 2013; 52:568-9. [PMID: 22157429 DOI: 10.1177/0009922811430526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Aliza B Solomon
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA.
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37
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Resection of a duodenal web using single-incision pediatric endosurgery. J Pediatr Surg 2011; 46:989-93. [PMID: 21616267 DOI: 10.1016/j.jpedsurg.2011.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 01/16/2011] [Accepted: 01/16/2011] [Indexed: 02/07/2023]
Abstract
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.
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Successful endoscopic treatment of a double duodenal web in an infant. Gastrointest Endosc 2011; 73:401-3. [PMID: 20869053 DOI: 10.1016/j.gie.2010.06.052] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 06/28/2010] [Indexed: 12/11/2022]
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