Laparoscopic repair of a duodenal web in a 6-year-old male: A case report

Failure of recanalization of the duodenal lumen may result in a variety of pathological conditions ranging from complete duodenal atresia to a duodenal web with or without fenestration. Duodenal webs typically present in the antenatal and neonatal period with signs of intestinal obstruction. Delayed presentations beyond infancy are rare and could lead to diagnostic challenges. A 6-year-old male born in Haiti presented with lifelong intermittent postprandial vomiting and failure to thrive, managed conservatively with small frequent meals prior to immigration to the United States. After establishing pediatric care, poor weight gain prompted further evaluation. Upper gastrointestinal contrast studies demonstrated proximal duodenal dilation with delayed contrast passage. Upper endoscopy confirmed a fenestrated duodenal web located in the second portion of the duodenum near the ampulla of Vater. The patient underwent laparoscopic duodenal mobilization, followed by intraoperative EGD to assist in the localizing the duodenal web, followed by creation of a side-to-side duodeno-duodenostomy in a single layer, interrupted fashion. Postoperative course was uncomplicated. A contrast study was completed on postoperative day four demonstrated normal passage of contrast without leak. That day we started the patient on clear liquids PO and progressively advanced them to a regular diet which he tolerated. The patient was discharged on postop day 6. At 3-month follow-up, he remained asymptomatic and had gained 6.8 kg. Duodenal web should be included in the differential diagnosis of children who have chronic vomiting. The laparoscopic repair of duodenal webs beyond infancy seems safe and effective.