Duodenal web associated with malrotation and review of literature
A 1-day-old baby girl, born by normal spontaneous vaginal delivery, was evaluated for abdominal distension and history of having not passed meconium. An abdominal X-ray was suspicious for malrotation (Fig. ). The patient did not have any evidence of sepsis. An echocardiogram ruled out any congenital cardiac anomalies.\nThe patient underwent an exploratory laparotomy; findings demonstrated a distended duodenum with cecum and appendix at the left upper quadrant fixed by Ladd's bands. The contents of the stomach could not be milked down distally. A duodenotomy incision identified a large duodenal web with a blind pouch (Fig. ). Distal to the web, the duodenum had normal caliber lumen. The duodenal web was resected and the duodenotomy was closed primarily. The cecum was positioned in the left upper quadrant. An appendectomy was performed and the abdomen closed primarily.\nPostoperative care included monitoring in neonatal intensive care unit. Upper GI series (Figs and ) demonstrated no evidence of leakage. The patient tolerated a trial of pedialyte feedings and was subsequently discharged home.