CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2019; 02(01): 069-073
DOI: 10.1055/s-0039-1683770
Case Report
Indian Society of Gastrointestinal and Abdominal Radiology

Duodenal Stenosis with Diaphragmatic Hernia—A Rare Combination—Delayed Diagnoses with Barium Study

Rupa Ananthasivan
1  Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
,
Sudarshan Rawat
1  Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
,
Pramesh Reddy
1  Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
,
Pooja G. Patil
1  Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
,
Chittur Narendra Radhakrishnan
2  Department of Pediatric Surgery, Manipal Hospital, Bangalore, Karnataka, India
› Author Affiliations
Further Information

Publication History

Received: 30 August 2018

Accepted after revision: 03 January 2019

Publication Date:
24 June 2019 (online)

  

Abstract

Duodenal stenosis is part of a spectrum of disorders due to non-cannulization of the fetal gut lumen occurring in 11 to 13 weeks of fetal life. The diagnosis is often made in the neonatal period owing to bilious vomiting. The authors present a case of a 9-year-old boy who was diagnosed by an upper gastrointestinal study that showed a hugely dilated stomach filled with food residue and a dilated first part of the duodenum with an abrupt narrowing in the second part of the duodenum in keeping with duodenal stenosis. There was no associated malrotation (a known association), but the delayed images showed a surprising finding of herniation of large bowel loops into the thorax suggestive of a congenital diaphragmatic hernia (Bochdalek type). Both these findings were confirmed on surgery, and the patient underwent duodenoduodenostomy and diaphragmatic hernia repair and is doing well on follow-up. This case is unusual due to the rare association of duodenal stenosis with congenital diaphragmatic hernia and delayed diagnosis. Both these pathologies most often present in the neonatal period, and delayed diagnosis is most often seen with associated trisomy 21 that was not the case in our patient.