Abstract
Duodenal stenosis is part of a spectrum of disorders due to non-cannulization of the
fetal gut lumen occurring in 11 to 13 weeks of fetal life. The diagnosis is often
made in the neonatal period owing to bilious vomiting. The authors present a case
of a 9-year-old boy who was diagnosed by an upper gastrointestinal study that showed
a hugely dilated stomach filled with food residue and a dilated first part of the
duodenum with an abrupt narrowing in the second part of the duodenum in keeping with
duodenal stenosis. There was no associated malrotation (a known association), but
the delayed images showed a surprising finding of herniation of large bowel loops
into the thorax suggestive of a congenital diaphragmatic hernia (Bochdalek type).
Both these findings were confirmed on surgery, and the patient underwent duodenoduodenostomy
and diaphragmatic hernia repair and is doing well on follow-up. This case is unusual
due to the rare association of duodenal stenosis with congenital diaphragmatic hernia
and delayed diagnosis. Both these pathologies most often present in the neonatal period,
and delayed diagnosis is most often seen with associated trisomy 21 that was not the
case in our patient.
Keywords
diaphragmatic - duodenal - hernia - stenosis
