Congenital duodenal web: successful management with endoscopic dilatation

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.

• References

• 1 Lawrence MJ, Ford WD, Furness ME et al. Congenital duodenal obstruction: early antenatal ultrasound diagnosis. Pediatr Surg Int 2000; 16: 342-345
• 2 Bailey PV, Tracy Jr. TF, Connors RH et al. Congenital duodenal obstruction: a 32-year review. J Pediatr Surg 1993; 28: 92-95
• 3 Mustafawi AR, Hassan ME. Congenital duodenal obstruction in children: a decade's experience. Eur J Pediatr Surg 2008; 18: 93-97
• 4 Beeks A, Gosche J, Giles H et al. Endoscopic dilatation and partial resection of a duodenal web in an infant. J Pediatr Gastroenterol Nutr 2009; 48: 378-381
• 5 Grosfeld JL, Roscorla FJ. Duodenal atresia and stenosis: Reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance and long term follow up. World J Surg 1993; 17: 301-309
• 6 Asabe K, Oka Y, Hoshino S et al. Modification of endoscopic management of congenital duodenal stenosis. Turk J Peidiatr 2008; 50: 182-185
• 7 Mochizuki K, Obatake M, Kosaka T et al. Endoscopic balloon dilatation for congenital membrane stenosis in the jejunum in an infant. Pediatr Surg Int 2011; 27: 91-93
• 8 Huang MH, Bian HQ, Liang C et al. Gastroscopic treatment of membranous duodenal stenosis in infants and children: report of 6 cases. J Pediatr Surg 2015; 50: 413-416
• 9 Norman Jr CH, Pacis AB. Congenital Duodenal Web in an Adult. J Natl Med Assoc 1978; 70; 797-798
• 10 Sarin YK, Sharma A, Sinha S et al. Duodenal webs: an experience with 18 patients. J Neonatal Surg 2012; 1: 20
• 11 Kay GA, Lobe TE, Custer MD et al. Endoscopic laser ablation of congenital duodenal webs in the newborn: a case report of limited success with criteria for patient selection. J Pediatr Surg 1992; 27: 279-281
• 12 Torroni F, De Angelis P, Caldaro T et al. Endoscopic membranectomy of duodenal diaphragm: pediatric experience. Gastrointest Endosc 2006; 63: 530-531
• 13 Barabino A, Gandullia P, Arrigo S et al. Successful endoscopic treatment of a double duodenal web in an infant. Gastrointest Endosc 2011; 73: 401-403
• 14 DiMaio CJ, Kamal N, Hogan CM et al. Pediatric therapeutic endoscopy: endoscopic management of a congenital duodenal web. Gastrointest Endosc 2014; 80: 166-167