duodenal web

Newborn with
bilious vomiting. AXR AP (above) shows a double bubble sign with a dilated stomach to the left of the spine and a dilated duodenum to the right of the spine. Oblique images from an upper GI show a dilated duodenal bulb projecting over the vertebral bodies (lower right) and a small amount of contrast entering the second part of the duodenum (lower left).The diagnosis was duodenal web.
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A duodenal web, diaphragm or intraluminal diverticulum refers to a complete or incomplete obstruction at the duodenum due to a membranous web or intraluminal diverticulum. There is usually a small aperture at the center differentiating this from duodenal atresia.

Epidemiology

Although they are frequently congenital and occur in the pediatric population, some can present in adults and may also be acquired . The presentation can be variable depending on the size of the aperture.

Pathology

They have a tendency to occur at the 2 part of the duodenum .

Associations

Radiographic features 

Plain radiograph

If severely obstructive may show a double bubble sign.

Fluoroscopy

Can typically give a "windsock sign" (gradual ballooning of the duodenal diaphragm) or "halo sign" due to the web projecting caudally into the duodenal lumen.

Duodenal dimple sign; when pressure is exerted by NG tube on the obstructive web can cause dimpling of duodenal wall nearby.

Ultrasound 
  • may show a dilated stomach and proximal duodenum
  • may how a hypoechoic intraluminal diverticulum

Differential diagnosis

Imaging differential considerations include:

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu duodenales Web:
Pancreas
anulare
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Duodenalatresie
 
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