Published: 2016-12-14

Incomplete duodenal obstruction: a rare and late presentation

Almoutaz A. Eltayeb, Ibrahim A. Ibrahim


Background: Incomplete duodenal obstruction accounts for only 2% of all duodenal anomalies. Because of its rarity those patients can be easily misdiagnosed and delayed in their presentation. The aim of this study is to assess these rare conditions with its delayed presentation and their outcome.

Methods: Nineteen cases presented with incomplete duodenal obstruction during the period from January 2010 to January 2015. Cases with complete duodenal obstruction were excluded from the study. None of those nineteen cases were diagnosed antenatal. The assessment parameters were; their provisional preoperative diagnosis, definite post-operative diagnosis, complications related to miss or delayed diagnosis and their final outcome.  

Results: All nineteen cases except six presented with persistent or recurrent attacks of vomiting since birth. Their provisional clinical diagnosis was malrotation in 9 cases, duodenal stenosis in 6 cases and atresia in 4. Their final diagnosis was; duodenal stenosis or web in fifteen cases, preduodenal portal vein in two, superior mesenteric artery syndrome in one case and duodenal hematoma in one case. The cause of misdiagnosis was related to lack of experience that leads to unsuccessful exploration or delayed surgical intervention. The post-operative complications occurred in 26.3% of cases. No mortality encountered in this study.

Conclusions: Rare causes of incomplete duodenal obstruction should be looked for routinely to avoid delayed presentation, misdiagnosis and unsuccessful exploration.


Incomplete duodenal obstruction, Mucosal web, Duodenal stenosis, Preduodenal portal vein

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Redel CA, Jeff ZR. Anatomy and anomalies of the stomach and duodenum. In: Feldman Mea, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 2nd ed. Philadelphia: W. B. Saunders Co.; 1997.

Ladd AP, Madura JA. Congenital duodenal anomalies in the adult. Arch Surg. 2001;136(5):576-84.

Bailey PV, Tracy TF Jr, Connors RH, Mooney DP, Lewis JE, Weber TR. Congenital duodenal obstruction: a 32-year review. J Pediatr Surg. 1993;28:92-5.

Gray SW, Skandalakis JH. The embryological basis for treatment of congenital defects. In: Gray SW, Skandalakis JH, eds. Embryology for Surgeons. 1st ed. Philadelphia, PA: Saunders; 1972: 177-217.

Gourevitch A. Duodenal atresia in the newborn. Ann Roy Coll Surg Engl. 1974;148:141.

De Backer A, Bové T, Vandenplas Y, Peeters S, Deconinck P. Contribution of endoscopy to early diagnosis of hypertrophic pyloric stenosis. J Pediatr Gastroenterol Nutr. 1994;18:78-81.

Escobar MA, Ladd AP, Grosfeld JL, West KW, Rescorla FJ, Scherer LR 3rd, et al. Duodenal atresia and stenosis: Long-term follow-up over 30 years. J Pediatr Surg. 2004;39(6):867-71.

Knight HO. An anomalous portal vein with its surgical dangers. Ann Surg. 1921;74:697-9.

Baglaj M, Gerus S. Preduodenal portal vein, malrotation and high jejunal atresia: a case report. J Pediatr Surg. 2012;47:E27-30.

Yi SQ, Tanaka S, Tanaka A, Shimokawa T, Ru F, Nakatani T. An extremely rare inversion of the preduodenal portal vein and common bile duct associated with multiple malformations Report of an adult cadaver case with a brief review of the literature. Anat Emberyol. 2004;208:87-96.

Mordehai J, Cohen Z, Kurzbart E, Mares AJ. Preduodenal portal vein causing duodenal obstruction associated with situs inversus, intestinal malrotation and polysplenia: a case report. J Pediatr Surg. 2002;37:E5.

Choi SO, Taegu PWH. Preduodenal portal vein: a cause of prenatally diagnosed duodenal obstruction. J Pediatr Surg. 1995;30:1521-2.

Abbas MA, Collins JM, Olden KW. Spontaneous intramural small bowel hematoma: imaging findings and outcome. AJR Am J Roentgenol. 2002;179:1389-94.12.

Borsaru AD, Nandurkar D. Intramural duodenal haematoma presenting as acomplication after endoscopic biopsy. Australas Radiol. 2007;51:378-80.

Le Moigne F, Lamboley JL, Vitry T, Stoltz A, Galoo E, Salamand P, et al. Superior mesenteric artery syndrome: a rare etiology of upper intestinal obstruction in adults. Gastroenterol Clin Biol. 2010;34:403-6.

Kay S, Yoder S, Rothenberg S. Laproscopic duodenoduodenostomy in the neonate. J Pediatr Surg. 2009;44:906-8.

Van Rijn RR, Van Lienden KP, Fortuna TL, D’Alessandro LC, Connolly B, Chait PG. Membranous duodenal stenosis: initial experience with balloon dilatation in four children. Eur J Radiol. 2006;59:29-32.

Splide TL, St Peter SD, Keckler SJ, Holcomb GW 3rd, Snyder CL, Ostlie DJ. Open vs. laparoscopic repair of congenital duodenal obstructions: a concurrent series. J Pediatr Surg. 2008;43:1002-5.

Grosfeld JL, Rescorla FJ. Duodenal atresia and stenosis: Reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance and long-term follow-up. World J Surg. 1993;17(3):301-9.

Ein SH, Kim PC, Miller HA. The late nonfunctioning duodenal atresia repair--a second look. J Pediatr Surg. 2000;35(5):690-1.

Okada PJ, Hicks B. Neonatal surgical emergencies. Clin Pediatr Emerg Med. 2002;3(1):3-13.