Congenital duodenal anomalies in the adult

Background: Duodenal anomalies are defects in em bryologic development and usually present as gastric outlet obstruction in infancy or early childhood . Occasionally, they remain asymptomatic until adulthood and, because they are unusual, may not be diagnosed. Hypothesis: Based on current experience and review of the literature, recog nition of diagnosis and the preferred methods of treatment of duodenal anom alies can be recommended. Design: Retrospective study of congenital duodenal anomalies in adults. Setting: Tertiary care university medical center. Patients: Twenty-nine patients were observed and treated between 1983 and 1 999 (19 women and 10 men; mean +/- SD age, 52 +/- 16 years). Twenty patient s had duodenal webs, 7 had annular pancreata, and 2 had both. Nausea, vomit ing, abdominal pain, and weight loss were predominant symptoms in all group s. Peptic ulceration occurred in 13 of 20 patients with webs but in none of those with annular pancreata or combined anomaly. Main Outcome Measures: Surgical outcomes including postoperative complicati ons, deaths, and resolution of preoperative symptoms. Results: The treatment for patients with duodenal webs was transduodenal we b excision and duodenoplasty in 19 of 22. Patients with annular pancreata w ere treated by transection of the annulus and duodenoplasty (n=4) and proxi mal duodenal bypass (n=3). There were no operative deaths, but 44% of patie nts had some complications. No pancreatic fistulas occurred in patients who had division of an annular pancreas. Outcome was considered excellent or g ood in 17 of 20 patients with duodenal webs, 4 of 7 with annular pancreata, and 2 of 2 with the combined anomaly. Conclusions: Duodenal anomalies are rare in adults. Duodenal webs are best managed by transduodenal excision and duodenoplasty. Annular pancreas is ge nerally best treated bp duodenal bypass to the distal duodenum or the jejun um. Annulus division call be carried out if the annulus is extramural, with out duodenal stenosis, and if access to the pancreaticobiliary sphincters i s necessary.