2023 Volume 59 Issue 4 Pages 764-769
A 28-eight-year-old female had a history of Ladd surgery for malrotation during her neonatal period and two surgeries for adhesive ileus until the age of two years. At the age of 28, she was diagnosed as having duodenal obstruction during a medical checkup at her workplace and was referred to our hospital for a thorough examination. Contrast-enhanced Computed Tomography showed marked gastric and duodenal dilatation, and the upper gastrointestinal series failed to confirm the progression of the contrast medium from the duodenal bulb in a short period of time. Upper gastrointestinal endoscopy showed a blind end at the distal end of the duodenum with no endoscopic evidence of migration. On the basis of the above, we suspected duodenal stenosis due to postoperative adhesion and decided to perform surgery. When the abdomen was opened, a nonrotational type of malrotation was observed. After the adhesion was released, an attempt was made to advance the nasoduodenal tube from the bulb for the purpose of decompression, but this was unsuccessful. Suspecting a membranous obstruction at this point, the descending duodenal leg wall was incised, and a Windsock-type membranous stenosis with a pinhole in the center was confirmed. Since it was difficult to confirm the duodenal papilla, a bypass with lateral anastomosis of the duodenum–upper jejunum was performed. However, postoperatively, the patient developed a passage obstruction owing to adhesion after the bypass, requiring reoperation, dissection of the duodenal upper jejunal bypass, and resection of the duodenal web. Two years after surgery, Symptoms have not flared up and she is back to work in good health.
