Congenital Duodenal Obstruction: Diagnostic Challenges and Surgical Outcomes in Libya Case Series
Keywords:
Duodenal stenosis, Delayed diagnosis, Obstruction, upper gastrointestinal tract, Duodenal webAbstract
Background: Congenital duodenal obstruction [CDO] is a rare cause of upper intestinal obstruction in children. While most cases are diagnosed during the neonatal period, partial obstruction may remain undetected until later infancy or childhood, leading to delayed diagnosis and chronic gastrointestinal symptoms.
Case Presentation: We report three pediatric cases of congenital duodenal obstruction managed at Misrata Medical Center, Libya. The first case involved a 19-month-old female with chronic non-bilious vomiting, failure to thrive, and recurrent respiratory infections secondary to a congenital duodenal web associated with patent ductus arteriosus. The second case was a 6-month-old infant with Down syndrome and annular pancreas presenting with persistent vomiting and severe malnutrition. The third case involved a neonate with a congenital duodenal web presenting shortly after birth with vomiting and melena. All patients underwent successful surgical correction with excellent postoperative recovery.
Conclusion: Congenital duodenal obstruction [CDO] may present beyond the neonatal period with nonspecific symptoms, resulting in delayed diagnosis. Persistent vomiting and growth failure should prompt early radiological evaluation. Early recognition and timely surgical intervention are essential to improve nutritional and clinical outcomes.
References
(1) Holcomb GW, Murphy JP, Ostlie DJ. Congenital duodenal obstruction. In: Ashcraft’s Pediatric Surgery [Internet]. Available from: Basic Medical Key
(2) Al-Momani H, Al-Harbi M, Al-Omran M. Congenital duodenal obstruction: outcomes and surgical management. Ann Pediatr Surg. 2016;12(3):95–101. Available from: PubMed Central
(3) Morris G, Kennedy A, Cochran W. The double bubble sign: duodenal atresia and associated genetic etiologies. Fetal Diagn Ther. 2020;47(2):98–103. Available from: Karger Publishers
(4) Kaddah S, Bahgat S, Abdelhamid A. Congenital duodenal obstruction in neonates and infants: diagnostic and management challenges. Children (Basel). 2020;7(8):99. Available from: MDPI Children
(5) Zhang X, Chen Y, Liu H. Delayed presentation of congenital duodenal obstruction: imaging findings and Imaging in Medicine and Surgery
(6) Al-Momani H, Al-Harbi M, Al-Omran M. Congenital duodenal obstruction: associated anomalies and surgical outcomes. Medicina (Kaunas). 2025;61(2):171. Available from: MDPI Medicina
(7) Bailey PV, Tracy TF, Connors TR, Monney DP, Lewis JE, Weber TR. Congenital duodenal obstruction: A 32-year review. J Pediatr Surg. 1993;28(1):92–95. doi: 10.1016/s0022-3468(05)80364-1. [DOI] [PubMed] [Google Scholar]
(8) Akhtar J, Guiney EJ. Congenital duodenal obstruction. Br J Surg. 1992; 79:133–135. doi: 10.1002/bjs.1800790212. [DOI] [PubMed] [Google Scholar]
(9) Gray SW, Skandalakis JH. The embryological basis for the treatment of congenital defects. Philadelphia, PA: Saunders; 1972. Embryology for surgeons; pp. 177–178. [Google Scholar]
(10) Louw JH, Barnard CN. Congenital intestinal atresia: observation on its origin. Lancet. 1955; 2:1065. doi: 10.1016/s0140-6736(55)92852-x. [DOI] [PubMed] [Google Scholar
(11) Ann Saudi Med. 2007 Jul-Aug;27(4):289–292. doi: 10.5144/0256-4947.2007.289
(12) Kimura K, Tsugawa C, Ogawa K, Matsumoto Y, Asada S. Diamond-shaped anastomosis for congenital duodenal obstruction. Arch Surg. 1977; 112:1262–1263. doi: 10.1001/archsurg.1977.01370100116026. [DOI] [PubMed] [Google Scholar]
(13) Waz A, Matta H, Jacobsz A, Trad O, Al-Salem AH. Congenital duodenal diaphragm in eight children. Ann Saudi Med. 2004;24(3):193–197. doi: 10.5144/0256-4947.2004.193. [DOI] [PMC free article] [PubMed] [Google Scholar]
(14) Chen Y, et al. Delayed presentation of congenital duodenal stenosis: A case report and review. *J Pediatr Surg Case Rep.* 2023; 98:103581.
(15) Kaza S, et al. Congenital duodenal obstruction presenting beyond infancy. *Front Pediatr. * 2022; 10:935174.
(16) Pediatric Surgery Library (APSA). Congenital Duodenal Obstruction. 2023.
(17) StatPearls. Duodenal Atresia and Stenosis. National Library of Medicine; 2024.
(18) Radiopaedia. Duodenal web (windsock deformity) – imaging features. 2024.
(19) PubMed Central. Congenital duodenal obstruction: outcomes and surgical management. 2023.
(20) StatPearls Publishing. Duodenal Atresia and Stenosis [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: NCBI Bookshelf
(21) Choudhry MS, Rahman N, Boyd P, Lakhoo K. Duodenal atresia: associated anomalies, prenatal diagnosis and outcome. Pediatr Surg Int. 2009;25(8):727–730. Available from: PubMed Central
(22) Escobar MA, Ladd AP, Grosfeld JL, West KW, Rescorla FJ, Scherer LR, et al. Duodenal atresia and stenosis: long-term follow-up over 30 years. J Pediatr Surg. 1994;29(6):809–812. Available from: PubMed
(23) Zwink N, Jenetzky E, Schmiedeke E, et al. Cardiac anomalies in congenital duodenal obstruction: prevalence, risk factors, and clinical implications. Children (Basel). 2022;9(12):1901. AvaAvailable from: PubMed
(24) Zwink N, Schmiedeke E, Jenetzky E, et al. Cardiac anomalies associated with congenital duodenal obstruction: systematic review and meta-analysis. Children (Basel). 2023;10(3):451. Available from: PubMed Central
(25) Al-Momani H, Al-Harbi M, Al-Omran M. Congenital duodenal obstruction in Down syndrome patients: clinical presentation and surgical outcomes. Int J Surg Case Rep. 2020; 75:300–306. Available from: ScienceDirect
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Copyright (c) 2026 Mustafa El-ahmer، Hala Abuzagaia، Eman Alabani
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