PMC4798844_01
a Barium meal follow-through in a 9-year-old boy showed grossly dilation of the first and proximal second parts of the duodenum due to a membrane. b Endoscopy revealed duodenal obstruction with a tiny lumen. c Endoscopy showing the balloon catheter in situ.
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An abdominal (erect) x-ray showed a double bubble sign and barium meal follow-through (Fig. 1 a) revealed narrowing in the second part of the duodenum with dilated proximal duodenum and stomach. There was a narrowing in the second part of the duodenum just distal to the ampulla, with a tiny hole at the center with proximal duodenal dilatation ( Fig.1 b). Endoscopic dilatation of duodenal web was done with a 10-mm CRE balloon under fluoroscopic guidance (Fig. 1 c).
PMC4798844_02
a Barium meal follow-through of an 8-year-old girl showing duodenal obstruction with grossly dilation of the first and second parts of duodenum. b Endoscopic image showing narrowing just distal to the ampulla with bulging (bellowing) of the membrane and a tiny lumen. c A balloon catheter passing through the lumen of diaphragm.
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Her abdominal x-ray (erect) showed a double bubble sign and barium meal follow-through ( Fig. 2 a) revealed narrowing in the second part of the duodenum with a dilated proximal duodenum. UGI endoscopy showed dilation of the first and proximal second part of duodenum and narrowing with a tiny lumen in the second part of duodenum just distal to the papilla (Fig. 2 b). Endoscopic dilatation of duodenal web was done with a 10-mm CRE balloon dilator (Fig. 2 c) under fluoroscopic guidance and the post-dilation appearance was the same as in Patient 1.
PMC4798844_03
a Barium meal follow-through of a girl aged 2 years and 3 months demonstrating duodenal obstruction with grossly dilation of the first and proximal second parts of the duodenum. b Endoscopic image showing the duodenal diaphragm with a tiny central lumen. c Endoscopic image showing roomy duodenal lumen proximal to the obstruction and the balloon catheter in situ.
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Barium meal follow-through (Fig. 3 a) showed narrowing in the second part of the duodenum with a dilated proximal duodenum. UGI endoscopy showed a membrane-like obstruction with a tiny opening in the second part just distal to the papilla (the membrane was bellowing into the proximal dilated duodenum [wind-sock] due to reverse peristalsis, a characteristic picture of duodenal diaphragm) ( Fig. 3 b). Endoscopic dilatation of duodenal web was started with an 8-mm CRE balloon (Fig. 3 c).