Gut and Liver 2011; 5(1): 105-109 https://doi.org/10.5009/gnl.2011.5.1.105 A Case of Congenital Duodenal Web Causing Duodenal Stenosis in a Down Syndrome Child: Endoscopic Resection with an Insulated-Tip Knife
Author Information
Sang Seon Lee*, Seon Tae Hwang*, Nam Gil Jang, Hann Tchah*, Duk Young Choi, Hyun Young Kim§, and Eell Ryoo*
Departments of *Pediatrics, Emergency Medicine, Pediatric Cardiology, and §Surgery, Gachon University of Medicine and Science Graduate School of Medicine, Incheon, Korea

Eell Ryoo
© The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. All rights reserved.

Abstract
A 35-month-old girl visited our hospital with repetitive vomiting and abdominal distention; this was especially aggravated after the introduction of solid and semisolid foods. At 5 months of age, the patient, who had Down' syndrome, had undergone surgery for ventricular septal defect, atrial septal defect, and patent ductus arteriosus, and had subsequently been frequently hospitalized for respiratory infections and other viral infectious diseases. After her admission, the abdominal distension improved with fasting and intravenous fl uid therapy. Radiograph from a small-bowel series revealed a thin fi lling defect with a dilated duodenal bulb in the distal region of the second portion of the duodenum, suggesting a duodenal web, and endoscopy revealed duodenal stenosis. We therefore performed endoscopic resection with an insulated-tip knife because of the history of prior operations, fasting problems after operations, and respiratory infections. Seven days later, scar formation was noted on the second portion of the duodenum, the scope passed well at the excision site, and no retained food material was noted on the follow-up endoscopy. After the procedure, the patient' abdominal distention and repetitive vomiting subsided, and she was discharged with the ability to eat eat an ageappropriate normal diet. There were no specifi c symptoms or other complications for 1 year after the procedure. (Gut Liver 2011;5:105-109)
Keywords: Insulated-tip knife; Endoscopic electrocauterization; Duodenal stenosis; Duodenal web; Down syndrome
Abstract
A 35-month-old girl visited our hospital with repetitive vomiting and abdominal distention; this was especially aggravated after the introduction of solid and semisolid foods. At 5 months of age, the patient, who had Down' syndrome, had undergone surgery for ventricular septal defect, atrial septal defect, and patent ductus arteriosus, and had subsequently been frequently hospitalized for respiratory infections and other viral infectious diseases. After her admission, the abdominal distension improved with fasting and intravenous fl uid therapy. Radiograph from a small-bowel series revealed a thin fi lling defect with a dilated duodenal bulb in the distal region of the second portion of the duodenum, suggesting a duodenal web, and endoscopy revealed duodenal stenosis. We therefore performed endoscopic resection with an insulated-tip knife because of the history of prior operations, fasting problems after operations, and respiratory infections. Seven days later, scar formation was noted on the second portion of the duodenum, the scope passed well at the excision site, and no retained food material was noted on the follow-up endoscopy. After the procedure, the patient' abdominal distention and repetitive vomiting subsided, and she was discharged with the ability to eat eat an ageappropriate normal diet. There were no specifi c symptoms or other complications for 1 year after the procedure. (Gut Liver 2011;5:105-109)
Keywords: Insulated-tip knife; Endoscopic electrocauterization; Duodenal stenosis; Duodenal web; Down syndrome
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