Intermittent obstruction resulting from multiple intestinal webs

Delayed Presentation of Congenital Jejunal Web beyond the Neonatal Period

Congenital web of the gastrointestinal tract is a rare anomaly which may present at any site of the gastrointestinal tract. In cases with an intact membrane, the presenting symptoms may take the form of complete intestinal obstruction while in other cases with a fenestrated membrane, it may present with partial intestinal obstruction such as failure to thrive, volume depletion, or poor body-weight gain, representing a chronic condition. It is very rare for a jejunal web to present with retention of accidently ingested foreign body. In this report, we document a case of 14-month boy with retention of accidently ingested button battery who was found to have a jejunal web on surgical exploration. This case report stresses on the importance of prevention of ingestion of inanimate foreign bodies especially in young infants and that the absence of symptoms does not preclude presence of foreign body in children. Also, surgeons should be prepared to deal with other unsuspected findings intraoperatively. After a review of the literature, jejunal web should be considered in the differential diagnosis of chronic partial intestinal obstruction even in adults.

Three laparotomies later: extrinsic duodenal atresia from malrotation complicated by intrinsic duodenal and pyloric windsock webs

We present a term infant with the unusual findings of malrotation in combination with both duodenal and pyloric webs of windsock type, thus masquerading as postoperative bowel dysfunction and ultimately requiring three laparotomies. To the best of our knowledge these three findings in combination have not been previously reported. The dilemma of whether to perform a duodenotomy or not during malrotation repair and the importance of instrumenting the intestine from the duodenotomy site in both retrograde and antegrade directions are discussed.

Idiopathic small bowel diaphragm disease identified by laparoscopic-assisted double-balloon enteroscopy in a child: an integrated successful definitive therapeutic method

In adults, small bowel diaphragm disease is a rare complication of small bowel enteropathy secondary to the use of nonsteroidal antiinflammatory drugs. The main clinical manifestations are gastrointestinal bleeding and subacute obstruction, and management can be challenging. We present a case of a 5-year-old girl with small bowel diaphragm disease. To our knowledge, this is the first idiopathic case (no history of nonsteroidal antiinflammatory drug use) in the pediatric age group. This report describes an integrated successful definitive therapeutic method of double-balloon enteroscopy and minimal invasive bowel surgery for small bowel pathology.