Duodenal webs in the adult

Duodenal webs and diaphragms in the adult are congenital in origin and are rare. They are explained embryologically by the process of duodenal epithelial plugging and subsequent revacuolization. The symptoms may be insidious and appear late in life and consist of partial gastric outlet complaints. Two thirds of the patients will have other upper GI problems, some of which may be related to the antral distension and stasis produced by the web. Peptic ulcer disease is common but may resolve when the web is excised. Diagnosis can be made by contrast duodenography but is more definitive with endoscopy. Therapy should be directed at web excision if possible. Associated ulcer disease should be selectively approached. The results of therapy in the reported cases have been successful when the web is surgically excised without additional ulcer procedures.