Clin Endosc.  2014 Nov;47(6):568-570. 10.5946/ce.2014.47.6.568.

Endoscopic Diagnosis of Duodenal Stenosis in a 5-Month-Old Male Infant

• Nicholson
• Acra SA
• Chung DH
• Rosen MJ

• KMID: 2134497
• DOI: http://doi.org/10.5946/ce.2014.47.6.568

Abstract

Duodenal stenosis and duodenal atresia are well-known gastrointestinal anomalies in patients with Down syndrome. Although duodenal atresia presents early and classically with vomiting in the immediate neonatal period, the presentation of duodenal stenosis can be significantly more subtle and the diagnosis delayed. Here, we describe the case of a 5-month-old male infant with Down syndrome and delayed presentation of high-grade duodenal stenosis diagnosed endoscopically. Pediatric gastroenterologists should include duodenal stenosis in the differential diagnosis of older infants and children with vomiting and should be familiar with the endoscopic appearance of this lesion.

Keyword

Duodenal obstruction; Down syndrome; Hematemesis

MeSH Terms

Child
Constriction, Pathologic*
Diagnosis*
Diagnosis, Differential
Down Syndrome
Duodenal Obstruction
Hematemesis
Humans
Infant*
Male
Vomiting

Figure

• 

  Fig. 1 Endoscopic images of congenital duodenal stenosis. (A) Duodenal bulb with an annular structure and no appreciable lumen. (B) Closer view of the villous mucosa in the center of the structure.

• 

  Fig. 2 Upper gastrointestinal series showing a dilated duodenal bulb and narrowing of the second portion of the duodenum (arrows), consistent with congenital duodenal stenosis.

Reference

1. Escobar MA, Ladd AP, Grosfeld JL, et al. Duodenal atresia and stenosis: long-term follow-up over 30 years. J Pediatr Surg. 2004; 39:867–871. PMID: 15185215.

2. Fabia J, Drolette M. Malformations and leukemia in children with Down's syndrome. Pediatrics. 1970; 45:60–70. PMID: 4243491.

3. Dalla Vecchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer LR, Engum SA. Intestinal atresia and stenosis: a 25-year experience with 277 cases. Arch Surg. 1998; 133:490–496. PMID: 9605910.

4. Vinocur DN, Lee EY, Eisenberg RL. Neonatal intestinal obstruction. AJR Am J Roentgenol. 2012; 198:W1–W10. PMID: 22194504.

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; 17:301–309. PMID: 8337875.

6. Savino A, Rollo V, Chiarelli F. Congenital duodenal stenosis and annular pancreas: a delayed diagnosis in an adolescent patient with Down syndrome. Eur J Pediatr. 2007; 166:379–380. PMID: 17043846.

7. Chhabra R, Suresh BR, Weinberg G, Marion R, Brion LP. Duodenal atresia presenting as hematemesis in a premature infant with Down syndrome. Case report and review of the literature. J Perinatol. 1992; 12:25–27. PMID: 1532826.

8. Sachs BF, Feldman W. Upper gastrointestinal bleeding associated with congenital duodenal stenosis and Down's syndrome. Clin Pediatr (Phila). 1973; 12:21A passim.

9. Takeuchi S, Tamate S, Nakahira M, Kadowaki H. Esophagitis in infants with hypertrophic pyloric stenosis: a source of hematemesis. J Pediatr Surg. 1993; 28:59–62. PMID: 8429475.

10. Kimura K, Mukohara N, Nishijima E, Muraji T, Tsugawa C, Matsumoto Y. Diamond-shaped anastomosis for duodenal atresia: an experience with 44 patients over 15 years. J Pediatr Surg. 1990; 25:977–979. PMID: 2213450.