[Clinical features of delayed diagnosis in congenital duodenal obstruction]

Delayed diagnosis in two cases of congenital duodenal obstruction was discussed. Case 1. Ten-month-old baby girl with Down's syndrome was admitted to the hospital because of vomiting of milk. Wall-like obstruction was found in the second part of duodenum. Case 2. One-year-old boy infant with Down's syndrome showed a stack of coin in the duodenum on admission. Wall-like obstruction was found in the second part of duodenum. Diagnosis of duodenal obstruction is sometimes delayed in Down's syndrome. Symptom such as vomiting and growth retardation might be ignored in a child with Down's syndrome. A large hole was found in the center of the obstruction in both cases; 4 mm in diameter in case 1, 3 mm in case 2. Papilla of Vater opened at the anal side of the obstruction. These structural particularities played a role in making symptom of duodenal obstruction obscure. Mural obstruction of duodenum was observed in both cases. The obstructions were, in shape, similar to the membraneous stenosis of the duodenum. However, they were not membranes but walls as thick as 4-5 mm. Wall-like duodenal obstruction has not been reported in the literature. It can not be concluded whether mural obstruction in our cases is a new subtype of duodenal obstruction or not.