Congenital Duodenal Web in 1 Month Old Girl

Background: Congenital web of the gastrointestinal tract is a rare anomaly causing gastrointestinal obstruction in infants and children. It is a rare condition with approximately 100 cases reported in the literature with a reported incidence ranging from 1 in 10, 000 to 1 in 40, 000. The severity of symptoms and the age of onset vary according to the size and location of the web, and if the obstruction is total or partial. When the obstruction is incomplete, as it was in our case, the clinical symptoms are variable and the diagnosis can be difficult. Case Presentation: A one month old girl was hospitalized with history of vomiting since she was born. Frequency of vomiting about 2 to 3 episodes per day with volume was 3-5 spoons without bilious color. There were no history of fever, jaundice, bloating. Laboratory investigation showed hypokalemia and cholestasis. Babygram radiography revealed single bubble appearance in cavum abdomen that suggested to Hypertrophic Pylorus Stenosis. Upper gastrointestinal study showed partial stenosis in pylorus and distal bulbus duodenum, duodenal web can not be excluded and not supported to hypertrophic pylorus stenosis. Patient underwent an exploratory laparotomy, which revealed a partial obstruction caused by duodenal web hole type at duodenal pars II pre ampula vater then web excision and duodenoplasty with primary hecting was conducted. On the 21th days post operation, she was discharged from hospital in good condition.