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Case Reports
. 2023 Aug 16;4(4):e347.
doi: 10.1097/PG9.0000000000000347. eCollection 2023 Nov.

Avoiding Surgery: Endoscopic Treatment of Congenital Duodenal Stenosis

Jessica V Baran  1   2 , Jerry M Brown  1   2 , Desiree Rivera-Nieves  2 , Sara Karjoo  2 , C Jason Smithers  3 , Michael J Wilsey  2
Affiliations
Case Reports

Avoiding Surgery: Endoscopic Treatment of Congenital Duodenal Stenosis

Jessica V Baran et al. JPGN Rep. .

Abstract

Duodenal stenosis is a rare congenital anomaly that is typically treated surgically, although endoscopic incisional therapy (EIT) and balloon dilation are minimally invasive alternatives. We present a case of a 15-month-old male with vomiting and difficulty tolerating solid food due to severe congenital duodenal stenosis. The patient underwent EIT and serial duodenal dilation to a diameter of 20 mm, which resulted in significant symptom improvement. Intralesional corticosteroid injection (ISI) was administered to help prevent the duodenal septum from restricturing. The combination of EIT, balloon dilation, and ISI was successful in treating the patient's congenital duodenal stenosis and avoided the need for surgery. However, further studies are required to confirm the efficacy of this treatment approach in this patient population. This report highlights the potential of this minimally invasive approach as an alternative to surgical intervention in the management of congenital duodenal stenosis.

Keywords: endoscopic balloon dilation; endoscopy; intralesional corticosteroid injection; membranous duodenal web; radial incisional therapy.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Fluoroscopic UGI series images showing: (A) “Double-bubble sign” with proximal duodenum dilated to 5.5 cm in diameter; and (B) high-grade duodenal obstruction associated with severe duodenal stenosis (arrow).
FIGURE 2.
FIGURE 2.
Significant duodenal dilation (A) noted proximal to the duodenal stenosis with pinhole orifice (B) just distal to the Ampulla of Vater on initial endoscopy. Bile was noted to pool (C) in the dilated duodenum. (B) Close-up view of pinhole orifice of the duodenal stenosis (arrow). (C) Endoscopic image showing balloon dilation of severe duodenal stenosis. (D) Patent duodenal orifice, status post endoscopic incisional therapy, and balloon dilation to 20 mm.
See this image and copyright information in PMC

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