Dual duodenal obstruction: an abdominal camouflage

Abstract

Congenital Double Duodenal Obstruction (DDO) is a clinical entity with a combination of annular pancreas and distal duodenal obstruction (either due to duodenal membrane or atresia). Hereby reporting a case of double duodenal obstruction in a 7 years boy, confirmed by barium meal, CECT abdomen and MRI abdomen. Bile-stained vomitus in neonates is the typical presentation of atresia or severe stenosis. Minimal duodenal obstruction in mild stenosis or membrane may present with clinical features, which include polyhydraminos, low birth weight, feeding intolerance, vomiting, failure to thrive, epigastric distension and visible gastric peristalsis. Duodeno-duodenostomy is the surgery of choice in cases of duodenal obstruction due to atresia, diaphragm and annular pancreas. The morbidity and mortality rate of patients with congenital duodenal obstruction is very high. Effective measures such as early diagnosis and intervention, proper preoperative preparation, nutritional support are urgently needed to improve the outcome. Low birth weight and prematurity significantly affect the outcome, associated anomalies account for most of the morbidity and mortality and early diagnosis result in better outcome.