Adult duodenal webs. A difficult diagnosis.

Intestinal obstruction in adults caused by congenital duodenal webs is uncommon. Roentgenographic and endoscopic diagnosis is difficult owing to frequently nonspecific roentgenographic findings and the obliteration of normal pyloric endoscopic anatomy. The ultimate diagnosis of this lesion is likely to be made at the time of cellotomy for suspected obstructing peptic ulcer disease with the observation of an unobstructed pylorus. We studied three recent cases and reviewed the pertinent literature, which demonstrated problems associated with preoperative and surgical diagnosis and management. Diagnosis of duodenal webs should be suspected in all patients with gastric or high duodenal obstruction and investigated by digital duodenal exploration at the time of surgery.