Symptomatic duodenal web diagnosed in a young adult

Abstract

A 21-year-old man developed non-bilious emesis and 40-pound weight loss over two months. Initial endoscopy revealed stomach distension and inability to advance beyond the first portion of the duodenum. He underwent exploratory laparotomy, which showed no clear cause of obstruction, and was transferred to a quaternary care pediatric hospital for further care. MRI showed high-grade proximal duodenal obstruction and a suspected duodenal web. Repeat endoscopy demonstrated a pinpoint hole in the proximal duodenum, confirming duodenal web. After endoscopic dilation, open duodenotomy with web lysis and closure in Heineke-Mikulicz fashion was performed. Post-operatively, the patient resumed a regular diet and had gained 50 pounds by his five-month follow-up visit. Predominantly diagnosed in infancy, duodenal web is an important cause of gastrointestinal obstruction with characteristic radiographic and endoscopic findings and should be considered in patients of all ages with unexplained proximal bowel obstruction.

Keywords

• Duodenal web
• Gastrointestinal obstruction
• Heineke-Mikulicz closure