Chew K, Bellemare S, Kumar A. Packed with pills - obstructing duodenal web in the setting of intestinal malrotation: A case report. World J Gastrointest Endosc 2023; 15(2): 77-83 [PMID: 36925649 DOI: 10.4253/wjge.v15.i2.77]
Corresponding Author of This Article
Kimberline Chew, MD, Doctor, Internal Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, United States. zchew@montefiore.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Feb 16, 2023; 15(2): 77-83 Published online Feb 16, 2023. doi: 10.4253/wjge.v15.i2.77
Packed with pills - obstructing duodenal web in the setting of intestinal malrotation: A case report
Kimberline Chew, Sarah Bellemare, Akash Kumar
Kimberline Chew, Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, United States
Sarah Bellemare, Division of Hepato-biliary Surgery, Montefiore Medical Center, Bronx, NY 10467, United States
Akash Kumar, Division of Gastroenterology, Montefiore Medical Center, Bronx, NY 10467, United States
Author contributions: Chew K and Kumar A contributed to manuscript writing and editing; Bellemare S and Kumar A supervised this study and captured the images used; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kimberline Chew, MD, Doctor, Internal Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, United States. zchew@montefiore.org
Received: December 14, 2022 Peer-review started: December 14, 2022 First decision: December 29, 2022 Revised: January 2, 2023 Accepted: January 16, 2023 Article in press: January 16, 2023 Published online: February 16, 2023 Processing time: 61 Days and 8.7 Hours
Abstract
BACKGROUND
The incidence of intestinal malrotation in adults has been reported to only be about 0.2%. Duodenal web as a cause of intestinal obstruction is rare, with an incidence of about 1:20000-1:40000. Furthermore, when described, these conditions are usually seen in early life and very infrequently in adulthood.
CASE SUMMARY
We report a case of a middle-aged woman with intestinal malrotation who presented with a three-month history of right-sided abdominal pain, early satiety, and a 22-pound weight loss. Patient underwent an esophagogastroduodenoscopy, which demonstrated numerous retained pills in a deformed first portion of the duodenum, concerning for a partial gastric outlet obstruction. An upper gastrointestinal series showed marked distention of the proximal duodenum with retained debris and the presence of a windsock sign, increasing the suspicion of a duodenal web. The patient subsequently underwent surgical intervention where a duodenal web with two lumens was noted and resected, opening the duodenum. There were over 150 pill capsules that were removed. The patient is doing well after this intervention.
CONCLUSION
Both intestinal malrotation and duodenal webs are infrequently encountered in the adult population. These pathologies can also present with nonspecific abdominal symptoms such as chronic abdominal pain and nausea. Hence, providers might not consider these pathologies in the differential for patients who present with vague symptoms which can lead to delay in management and increased mortality and morbidity.
Core Tip: Intestinal malrotation and duodenal web are gut pathologies that rarely occur or become symptomatic in the adult population. It is even rarer to see an association between the two which leads to intestinal obstruction. Furthermore, adults may present with vague gastrointestinal symptoms which can delay management and increase mortality. We report a case of intestinal obstruction due to a duodenal web in the setting of malrotation in a middle-aged female.
