Missed duodenal web with foreign body impaction in an operated case of midgut malrotation with Down′s syndrome - A diagnosis delayed by endoscopy

ABSTRACT

“Always look for duodenal obstruction in a case of malrotation”, this dictum has to be followed. The patient was operated for midgut malrotation at day 2 of life followed by foreign body removal by upper gastrointestinal endoscopy at 2 years of age. We report atwo and half year male child with Down′s syndrome who presented to us with history suggestive of recurrent upper gastrointestinal tract obstruction. During surgery a post sphincteric duodenum web was confirmed and foreign body (berry seed) which had impacted proximal to it was removed. The web was excised and the duodenum, split longitudinally, sutured transversely. The postoperative course was uneventful and patient is asymptomatic at follow up. This case illustrates that diagnosis was delayed for 2΍ years after initial presentation in early neonatal age. (Dig Endosc 2013;4(1):10–12)

Key Words:

Duodenal web - Foreign body - Midgut malrotation - Down’s syndrome - Upper gastrointestinal endoscopy.

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