Medical expert of the article
New publications
Developmental anomalies of the duodenum: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Atresia and congenital stenosis of the duodenum
Atresia, congenital stenosis and membranous adhesions of the duodenum are detected in the first day after birth: profuse vomiting, frequent regurgitation and other symptoms, high intestinal obstruction are characteristic. There is no stool. X-ray examination (contrast is introduced into the stomach through a thin tube) reveals gastric dilation and no flow of contrast agent into the stomach. If surgical treatment is impossible in the next 24 hours, newborns die from dehydration and exhaustion.
With partial narrowing of the lumen of the duodenum, the child's nutrition may be slightly disrupted or not disrupted at all. In the second case, the complaints of patients are uncharacteristic and narrowing of the lumen of the duodenum can be detected accidentally during an X-ray examination in an adult.
When examined by X-ray, congenital internal membranes and septa of the duodenum usually create a picture of symmetrical narrowing of very small extent (from 1-2 to 5 mm) depending on the thickness of the membrane. The relief of the intestinal mucosa is unchanged or extended folds are determined above the narrowing. With external scars, cords or additional ligaments (lig. cystoduodenocolicum), the narrowing areas have smooth, clear contours, their length does not exceed 0.5-1 cm.
Gastroduodenoscopic examination also significantly facilitates diagnosis: it reveals either a circular narrowing of a section of the duodenum, usually with an unchanged mucous membrane, or membranous septa, the congenital nature of which is easy for an experienced endoscopist to determine.
Symptoms
The clinical picture depends on the degree of compression. In adults, this is a feeling of rapid fullness of the stomach during meals, belching, nausea, and sometimes vomiting. With complete compression of the intestine, the symptoms are similar to those with its atresia and are detected from the first days after the birth of the child.
Congenital compression of the duodenum should be distinguished from compression due to adhesions in the abdominal cavity (periduodenitis, consequences of surgical interventions), etc.
Treatment is surgical.
Arteriomesenteric obstruction
Of greatest clinical significance are anomalies of the superior mesenteric artery and other congenital and constitutional disorders, which may result in a violation of the passage of the contents of the duodenum along its lower horizontal branch (the so-called arteriomesenteric obstruction). As is known, normally the superior mesenteric artery departs from the aorta, crosses the anterior surface of the lower horizontal branch of the duodenum, passing behind the pancreas, and then enters the mesentery of the small intestine. However, with some anomalies of its location, the presence of additional branches, as well as with pronounced lumbar lordosis, congenital short mesentery of the small intestine or its significant drooping downwards (pronounced enteroptosis, sudden weight loss), it can compress the duodenum, disrupting its patency. It is possible that in cases where symptoms of chronic arteriomesenteric obstruction (we prefer the term "duodenal arteriomesenteric compression") occur in old age, hardening of this artery due to atherosclerotic lesions is important.
Acute duodenal arteriomesenteric obstruction occurs suddenly due to a sharp expansion of the stomach or significant overfilling of it with food, as a result of which the intestine is pushed downwards, the mesentery of the small intestine is stretched and the superior mesenteric artery compresses the lower horizontal branch of the duodenum. The clinical picture is the same as with acute intestinal obstruction (sharp pain in the epigastric region).
Symptoms
The clinical picture of chronic duodenal arteriomesenteric compression: a feeling of heaviness and dull or severe pain and a feeling of “fullness” in the stomach (sometimes after eating even a small amount of food), occurring soon after eating, belching, and less often vomiting of eaten food.
Often these symptoms subside in a forced position (knee-elbow, sometimes on the side), in a standing position - they intensify. In most cases, the disease occurs at a young age, and gradually its symptoms intensify. In severe cases, attention is paid to the appearance of patients: these are asthenics with a flabby abdominal wall and a sagging belly.
Diagnostics
The diagnosis of arteriomesenteric obstruction (in our opinion, it is preferable to use the term "arteriomesenteric compression of the duodenum") is most easily confirmed by contrast radiographic examination, in which a short area of narrowing is detected at the intersection of the lower horizontal branch of the duodenum (at the transition to the jejunum) - compression by a section of the mesentery of the small intestine, in which the superior mesenteric artery passes. It is the compression by the artery that creates difficulty in the passage of contents along the lower horizontal branch of the duodenum.
In this case, expansion of its proximal part, increased peristalsis, spastic and antiperistaltic contractions, and in some cases even gastric expansion are observed. A more illustrative method is duodenography, in which a narrow transverse strip of enlightenment 1.5 cm or slightly more wide with smooth contours is detected in the lower horizontal part of the duodenum at the left edge of the lumbar vertebrae. The relief of the mucous membrane in this area is unchanged. Sometimes the passage of a contrast suspension through the narrowed area is restored when examining the patient in the knee-elbow position, which quite convincingly confirms the diagnosis. A characteristic localization of the narrowing zone of the duodenum with an unchanged mucous membrane is also detected during gastroduodenoscopy (with a sufficiently "deep" advancement of the duodenoscope - to the final part of the lower horizontal branch of the duodenum).
[ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ]
Treatment
Mainly conservative. High-calorie fractional meals (5-6 times a day) are recommended - to increase the body weight of patients and reduce gastroenteroptosis (tension of the mesentery of the small intestine and compression of the superior mesenteric artery of the duodenum are reduced). Appetite-improving agents are indicated: appetite infusion (in the form of an infusion), insulin injections of 4-6 U 30 minutes before meals, methandrostenolone, retabolil. To eliminate motor disorders of the duodenum, antispasmodics and metoclopramide (cerucal) are prescribed. In especially severe cases, at the beginning of treatment, which is advisable to carry out in the gastroenterology department of a therapeutic hospital, it is recommended to take the knee-elbow position for 30-60 minutes after meals, which reduces tension of the mesentery of the small intestine and compression of the lower horizontal branch of the duodenum. In severe cases, when conservative measures do not help, surgical treatment is indicated.
Duplication of the duodenum
Duplication of the duodenum is an extremely rare anomaly. In this case, there is an additional intestinal tube with a diameter of 1-4 cm, located parallel to the main one and having a common wall with it. Clinical symptoms are either absent, or pain in the epigastric region after eating, vomiting (with a delay in the duodenum duplication of food masses) are observed. The diagnosis is established by X-ray examination.
Treatment for severe clinical symptoms is surgical.
Enterogenous cysts of the duodenum can be single or multiple. When large, clinical symptoms of duodenal obstruction occur. The diagnosis is established by X-ray examination and duodenofibroscopy. Treatment is surgical.
[ 16 ], [ 17 ], [ 18 ], [ 19 ]
Compression of the duodenum
In rare cases, due to incomplete obliteration of the ventral mesentery, fibrous bands are formed, which are the cause of external constrictions of the duodenum; most often, compression of the upper half of the descending part of the duodenum by the ligament running from the gallbladder to the hepatic flexure of the colon is observed.
Stenosis caused by the annular, i.e. "ring-shaped", pancreas is typically located in the upper or middle third of the descending part of the duodenum, most often directly above the large papilla (of Vater) of the duodenum. Narrowing of the lumen is usually eccentric, since the accessory pancreas rarely represents a closed ring, but more often contains a section of connective tissue. The length of the narrowing is 2-3 cm, the contours are clear, smooth. The intestinal mucosa in this area is unchanged, represented by delicate, thin folds, and above and below the narrowing, the folds are thickened or normal. The length of the narrowed area and its diameter do not change with compression, a change in the patient's body position, and with additional examinations. Gastroduodenoscopy (the unchanged mucosa in the narrowing zone is noticeable) and computed tomography can facilitate diagnosis. Considering that compression of the duodenum most often occurs in adults against the background of compaction of the gland tissue due to chronic pancreatitis, this data can also be obtained using ultrasound.
Treatment is surgical. In case of minor narrowing of the lumen of the duodenum and absence of intestinal symptoms, it is sufficient to recommend fractional nutrition, a mechanically gentle diet.
Anomalies of the location of the duodenum
Anomalies of the duodenum location are relatively common. Thus, when the intestinal rotation is not completed during embryogenesis, the descending part of the duodenum does not turn to the left, passing into its lower horizontal part, but descends downwards, without a sharp topographic-anatomical border, passing into the jejunum. This anomaly has no clinical significance and is detected accidentally during an X-ray examination.
If there is a mesentery of the duodenum, it can form additional bends and kinks that prevent food from moving through it and, in some cases, cause attacks of pain accompanied by vomiting.
Sometimes the pain occurs when overeating and large portions of stomach contents enter the intestine. Often the pain is relieved by a certain position of the patient, which helps straighten out the kinks (lying on the back, on the side, in the knee-elbow position, etc.). The diagnosis is established by X-ray examination.
Treatment for severe clinical symptoms is surgical (fixation of the duodenum to the posterior wall of the abdominal cavity).
Congenital diverticula of the duodenum
Congenital diverticula of the duodenum have the same clinical picture as acquired ones. Before surgery, differential diagnosis with acquired diverticula is possible if the diverticulum is detected already in childhood.
[ 25 ], [ 26 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ], [ 32 ]
What do need to examine?