Simultaneous duodenal stenosis and duodenal web in a newborn

Failure of duodenal recanalization results in a spectrum of proximal bowel obstruction from stenosis to atresia. Associations between congenital duodenal obstruction and other congenital anomalies have been well documented although the coincidence of duodenal stenosis and duodenal web is incredibly rare, posing a unique diagnostic challenge. We report a case of a full-term 4-day-old female child presented with forceful, bilious emesis and poor oral intake with decreased frequency of urination, and stooling whose initial abdominal radiograph showed several loops of gas-filled bowel in the distal stomach and proximal duodenum mimicking the classic "double-bubble" sign. An upper gastrointestinal barium contrast study revealed distention of the duodenal bulb with an abrupt narrowing and subsequent dilation at the second portion of the duodenum raising the suggestion of multiple duodenal obstructions. Ladd's procedure was performed, and the stenotic and webbed segments were bypassed with a Kimura diamond-shaped duodenoduodenostomy.