Combined Extrinsic and Intrinsic Duodenal Obstruction in a Down's Syndrome Child: A Diagnostic Challenge

Julio Alberto Vazquez Gomez, Marta Bascuas Arribas , Henar Souto Romero , Pedro Borrego Jimenez , Sara Sirvent Cerda and Consuelo Pedron-Giner

Gastroenterology and Nutrition Section, Hospital Infantil Universitario Nino Jesus, Spain Department of Pediatric Surgery, Hospital Infantil Universitario Nino Jesus, Spain Department of Diagnostic Imaging, Hospital Infantil Universitario Nino Jesus, Spain

^*Correspondance to: Julio Alberto Vazquez Gomez 

 PDF  Full Text DOI: 10.25107/2474-1647.3218

Abstract

Introduction: Down's syndrome is associated with various gastrointestinal disorders such as motility disorders, autoimmune phenomena, and structural abnormalities. Within these pathologies, incomplete forms of intestinal occlusion pose a diagnostic challenge due to their larval symptomatology. Clinical Case: We present the case of a 2-year-old boy with Down?s syndrome. He was referred to Gastroenterology for projectile vomiting from the start of complementary feeding. An abdominal ultrasound, opaque enema, and manometry with rectal biopsy without alterations were provided, as well as negative serology for Coeliac disease. On examination, there was marked distension of the upper abdomen, with palpation of the intestinal loops. In the oesophagogastroduodenal transit, a partial obstruction of the second portion with associated malrotation was observed, which was corrected surgically. The symptoms reappeared 15 months later finding a duodenal web in the third portion. Discussion: Duodenal atresia affects 1 in 10,000 live births and may be associated with other congenital anomalies. Up to 30% have trisomy of chromosome 21. Duodenal web is an uncommon form, with incomplete obstructions presenting postprandial vomiting and distension of the upper hemiabdomen with visible peristalsis. The diagnostic test of choice is oesophagogastroduodenal transit and treatment requires surgical repair of the defect. Conclusion: Structural digestive manifestations associated with Down?s syndrome are a frequent cause of morbidity and mortality. Their management requires a high index of suspicion to indicate the necessary complementary tests, obtain an accurate diagnosis and establish early treatment

Keywords

Down&39;s syndrome; Duodenal atresia; Intestinal occlusion; Duodenal web; Oesophagogastroduodenal transit

Cite the article

Vazquez Gomez JA, Arribas MB, Romero HS, Jimenez PB, Cerda SS, Pedron-Giner C. Combined Extrinsic and Intrinsic Duodenal Obstruction in a Down's Syndrome Child: A Diagnostic Challenge. Clin Surg. 2021; 6: 3218..