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.
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Epidemiology
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.
Pathology
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
Associations
Radiographic features
Plain radiograph
If severely obstructive, may show a double bubble sign.
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.
Duodenal dimple sign: pressure exerted by a nasogastric tube on the obstructive web can cause dimpling of duodenal wall nearby. 5
Ultrasound
may show a dilated stomach and proximal duodenum
may show a hypoechoic intraluminal diverticulum
Differential diagnosis
Imaging differential considerations include:
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