Duodenal web presenting outside the neonatal period concurrently with malrotation and mid-gut volvulus

Abstract

Fetal development of the intestinal tract involves multiple embryological events at the culmination of which the duodenojejunal junction is fixed in the left upper quadrant and cecum in the right lower quadrant. Developmental anomalies affecting the normal rotation of the fetal intestines occur as frequently as 1% of the population. Patients with malrotation are at risk for midgut volvulus, a surgical emergency with potential catastrophic outcomes with an incidence of 1:6000. Congenital duodenal atresia and stenosis is a frequent cause of intestinal obstruction in neonates and the incidence is estimated to be between 1:4000–15000 livebirths. Developmental failure of the recanalization of the fetal duodenum leads to an intrinsic web or atresia. Classically, malrotation with midgut volvulus is often diagnosed in a previously healthy term neonate with bilious emesis. While duodenal webs can have a similar presentation, the concurrence of both pathological entities leading to bowel obstruction is rarely reported. In this report we present a case of a 2 year old previously asymptomatic male child presenting with bilious emesis and found to have malrotation with volvulus and a concurrent duodenal web. Keywords: Malrotation, Volvulus, Congenital duodenal web