Gut Liver.  2011 Mar;5(1):105-109.

A Case of Congenital Duodenal Web Causing Duodenal Stenosis in a Down Syndrome Child: Endoscopic Resection with an Insulated-Tip Knife

• Lee SS
• Hwang ST
• Jang NG
• Tchah H
• Choi DY
• Kim HY
• Ryoo E

Abstract

A 35-month-old girl visited our hospital with repetitive vomiting and abdominal distention; this was especially aggravated after the introduction of solid and semisolid foods. At 5 months of age, the patient, who had Down's syndrome, had undergone surgery for ventricular septal defect, atrial septal defect, and patent ductus arteriosus, and had subsequently been frequently hospitalized for respiratory infections and other viral infectious diseases. After her admission, the abdominal distension improved with fasting and intravenous fl uid therapy. Radiograph from a small-bowel series revealed a thin fi lling defect with a dilated duodenal bulb in the distal region of the second portion of the duodenum, suggesting a duodenal web, and endoscopy revealed duodenal stenosis. We therefore performed endoscopic resection with an insulated-tip knife because of the history of prior operations, fasting problems after operations, and respiratory infections. Seven days later, scar formation was noted on the second portion of the duodenum, the scope passed well at the excision site, and no retained food material was noted on the follow-up endoscopy. After the procedure, the patient's abdominal distention and repetitive vomiting subsided, and she was discharged with the ability to eat eat an age-appropriate normal diet. There were no specifi c symptoms or other complications for 1 year after the procedure.

Keyword

Insulated-tip knife; Endoscopic electrocauterization; Duodenal stenosis; Duodenal web; Down syndrome

MeSH Terms

Cicatrix
Communicable Diseases
Constriction, Pathologic
Diet
Down Syndrome
Ductus Arteriosus, Patent
Duodenal Obstruction
Duodenum
Endoscopy
Fasting
Follow-Up Studies
Heart Septal Defects, Atrial
Heart Septal Defects, Ventricular
Humans
Preschool Child
Respiratory Tract Infections
Vomiting
Duodenal Obstruction