Shin Hyun Deok
Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea.
World J Clin Cases. 2024 Jun 26;12(18):3622-3628. doi: 10.12998/wjcc.v12.i18.3622.
Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea, vomiting, and postprandial fullness. The treatment for this disease is mostly surgical. Endoscopic treatment techniques have been developed and attempted for this disease. Endoscopic radial incision and cutting (RIC) techniques are reportedly very effective in benign anastomotic stricture. This case report highlights the effectiveness and safety of endoscopic RIC as a minimally invasive treatment for adult congenital duodenal webs.
A 23-year-old female patient with indigestion was referred to a tertiary hospital. The patient complained of postprandial fullness in the epigastric region. Previous physical examinations or blood tests indicated no abnormalities. Computed tomography revealed an eccentric broad-based delayed-enhancing mass-like lesion in the second portion of the duodenum. Endoscopy showed an enlarged gastric cavity and a significantly dilated duodenal bulb; a very small hole was observed in the distal part of the second portion, and scope passage was not possible. Gastrografin upper gastrointestinal series was performed, revealing an intraduodenal barium contrast-filled sac with a curvilinear narrow radiolucent rim, a typical "windsock" sign. Endoscopic RIC was performed on the duodenal web. The patient recovered uneventfully. Follow-up endoscopy showed a patent duodenal lumen without any residual stenosis. The patient reported complete resolution of symptoms at the 18-month follow-up.
Endoscopic RIC may be an effective treatment for congenital duodenal webs in adults.
先天性十二指肠蹼在成人中罕见，可导致恶心、呕吐和餐后饱胀等多种症状。该病的治疗大多采用手术方式。内镜治疗技术已被开发并尝试用于此病。据报道，内镜下径向切开和切割（RIC）技术在良性吻合口狭窄治疗中非常有效。本病例报告强调了内镜RIC作为成人先天性十二指肠蹼微创治疗方法的有效性和安全性。
一名23岁消化不良的女性患者被转诊至一家三级医院。患者主诉上腹部餐后饱胀。既往体格检查或血液检查均未发现异常。计算机断层扫描显示十二指肠第二部有一个偏心的、基底较宽的延迟强化肿块样病变。内镜检查显示胃腔扩大，十二指肠球部明显扩张；在第二部远端观察到一个非常小的孔，无法通过内镜。进行了泛影葡胺上消化道造影，显示十二指肠内有一个钡剂造影剂充盈的囊袋，边缘有曲线状狭窄的透光区，典型的“风袋”征。对十二指肠蹼进行了内镜RIC治疗。患者恢复顺利。随访内镜检查显示十二指肠腔通畅，无任何残留狭窄。患者在18个月随访时报告症状完全缓解。
内镜RIC可能是成人先天性十二指肠蹼的一种有效治疗方法。
