Duodenal web

Last revised by Dr Yair Glick on 26 Sep 2021

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 center differentiating this from duodenal atresia

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

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

If severely obstructive, may show a double bubble sign.

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.

Duodenal dimple sign: pressure exerted by a nasogastric tube on the obstructive web can cause dimpling of duodenal wall nearby. 5

  • may show a dilated stomach and proximal duodenum
  • may show a hypoechoic intraluminal diverticulum

Imaging differential considerations include:

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4: intraluminal duodenal diverticulum (windsock sign)
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  • Case 5: on CT and MRI
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