CASE OF THE DAY 13 NOV

Question:

A 4 month old male with recurrent emesis following feeding and malnutrition.

What us your diagnosis?

Answer:

3) Duodenal web

findings:

• In scout film, gas distended stomach is seen.
• In upper GI , stomach is normal in size and contour. Duodenal bulb and proximal descending duodenum are markedly distended. The obstructed duodenum has a rounded contour suggestive of a windsock deformity.

Discussion:

• A duodenal web, diaphragmor intraluminal diverticulum refers to a complete or incomplete obstruction at the duodenum due to a membranous web or intraluminal diverticulum. There is usually a small aperture at the center differentiating this from duodenal atresia.
• Plain radiograph
• If severely obstructive may show a double bubble sign.
• Fluoroscopy
• Can typically give a “windsock sign” (gradual ballooning of the duodenal diaphragm) or “halo sign” due to the web projecting caudally into the duodenal lumen.
• Duodenal dimple sign; when pressure is exerted by NG tube on the obstructive web can cause dimpling of duodenal wall nearby. 
• Ultrasound 
• may show a dilated stomach and proximal duodenum
• may how a hypoechoic intraluminal diverticulum

Courtesy of Ali Hekmatnia,MD, Full Professor Department of Radiology Isfahan University of Medical Sciences.