Duodenal web

Last revised by Mostafa Elfeky on 15 Oct 2023

A duodenal web, diaphragm or intraluminal duodenal diverticulum (IDD) 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. There are many types of duodenal webs 6:

  • complete duodenal atresia (imperforate web)

  • imperforate intraluminal duodenal diverticulum (windsock web)

  • perforated duodenal web or perforated intraluminal duodenal diverticulum with either a central or eccentric opening

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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