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 can be 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; when pressure is exerted by NG tube on the obstructive web can cause dimpling of duodenal wall nearby. 5
- may show a dilated stomach and proximal duodenum
- may how a hypoechoic intraluminal diverticulum
Imaging differential considerations include:
- 1. Materne R. The duodenal wind sock sign. Radiology. 2001;218 (3): 749-50. Radiology (full text) - Pubmed citation
- 2. Berrocal T, Torres I, Gutiérrez J et-al. Congenital anomalies of the upper gastrointestinal tract. Radiographics. 19 (4): 855-72. Radiographics (full text) - Pubmed citation
- 3. Rha SE, Lee JH, Lee SY et-al. Duodenal diaphragm associated with long-term use of nonsteriodal antiinflammatory drugs: a rare cause of duodenal obstruction in an adult. AJR Am J Roentgenol. 2000;175 (3): 920-1. AJR Am J Roentgenol (full text) - Pubmed citation
- 4. Ladd AP, Madura JA. Congenital duodenal anomalies in the adult. Arch Surg. 2001;136 (5): 576-84. Arch Surg (link) - Pubmed citation
- 5. Lee Alexander Grant, Grant, Nyree Griffin. Grainger and Allison's Diagnostic Radiology Essentials. (2019) ISBN: 9780702034480