Complete duodenal membranes are usually diagnosed in the neonatal period. The presence of a fenestration may cause a delay in diagnosis. Our patient is a 27-month-old boy who presented with recurrent non-bilious vomiting that has been present since early childhood, in addition to increasing abdominal distention and failure to thrive. Despite multiple prior consultations and misdiagnoses of food allergy, an abdominal Xray showed markedly dilated gas-filled bowel, absence of the double-bubble sign, and the presence of a foreign body possibly causing obstruction. A computed tomography (CT) scan confirmed the dilated bowel to be the severely distended stomach with suspected duodenal obstruction in the second part. Endoscopic evaluation revealed a duodenal web with a 3 mm central fenestration and an associated duodenal stenosis. The simultaneous use of endoscopy and laparotomy enabled identification of the duodenal papilla and an anterolateral incision of the duodenal wall was performed to avoid damage to it. Partial web excision was performed and the duodenum was closed by a diamond-shaped anastomosis using absorbable sutures. The recovery period was uneventful, enteral feeding was started 5 days post-operatively, the child started gaining weight again and no more symptoms were reported at a 3-month follow-up appointment. Fenestrated duodenal membrane should be included in the differential diagnosis of infants and children who have a history of recurrent vomiting.
Ewida et al. (Sun,) studied this question.