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Duodenal web

A duodenal web, diaphragm or intraluminal diverticulum refers to a complete or incomplete obstruction at the duodenum due to a membranous web or intraluminal diverticulum. There is usually a small aperture at the centre differentiating this from a duodenal atresia

Although they are frequently congenital and occur in the paediatric population, some can can present in adults 3-4  and may also be acquired 3. The presentation can be variable depending on the size of the aperture. 

Pathology

They have a tendency to occur at the 2nd part of the duodenum 1 .

Associations

Radiographic features 

Abdominal radiograph

If severely obstructive may show a double bubble sign.

Ultrasound 
  • may show a dilated stomach and proximal duodenum. 
  • may how a hypoechoic intraluminal diverticulum
Fluoroscopy

Can typically give a "windsock sign" (gradual ballooning of the duodenal diaphragm) or "halo sign" due to the web projecting caudally into the duodenal lumen.

Differential diagnosis

Imaging differential considerations include

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