Persistent Nonbilious Vomiting in a Child: Possible Duodenal Webbing

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.

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

Chronic duodenal obstruction related to a congenital web is a rare anomaly that is sometimes difficult to diagnose preoperatively. A case of partial duodenal obstruction along with a foreign body by a congenital duodenal web in a 10-year- old girl is presented. She has had one year history of intermittent epigastric discomfort without nausea, vomiting and growth retardation. The studies including UGI series and gastroduodenoscopy disclosed a perforated web in the 2nd portion of the duodenum and a dark go stone just proximal to the web. Via a longitudinal duodenotomy across the web, the web was partly excised with preservation of ampulla of Vater and the duodenum was closed in transverse fashion. The aperture of ampulla of Vater was located at 7 o'clock direction of posterior surface of the duodenal web. This particular case reminds clinicians to consider a duodenal web in a youngster presenting with a longstanding foreign body in the duodenum as one of the underlying pathologies.

Congenital Duodenal Web in a Young Adult

Congenital duodenal web in adult life is an extremely rare condition, which results from an incomplete recanalization of the duodenum during early embryologic development. We report a case of congenital duodenal web in a 23-year-old man who complained of postprandial epigastric pain and fullness, as well as nausea since childhood. The plain abdomen showed a double-bubble sign. The UGI study showed a marked dilatation of the proximal duodenum and a delayed passage of barium into the third portion of the duodenum. Abdominal ultrasonography and CT revealed a marked dilatation of the proximal duodenum and a duodenal web with windsock deformity, which originated from the ampulla of Vater and extended to the third portion of the duodenum. A winsock web with a 0.9 cm eccentric aperture and a healed ulcer proximal to the ampulla of Vater were observed during a longitudinal duodenotomy. The web was excised circumferentially and the duodenum was closed transversely in a Heineke-Mikulicz fashion.